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Jiang C, Zhang Y, Fu F, Deng P, Chen H. A Shift in Paradigm: Selective Lymph Node Dissection for Minimizing Oversurgery in Early Stage Lung Cancer. J Thorac Oncol 2024; 19:25-35. [PMID: 37748691 DOI: 10.1016/j.jtho.2023.09.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/29/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
Systematic lymph node dissection has been widely accepted and turned into a standard procedure for lung cancer surgery. In recent years, the concept of "minimal invasive surgery (MIS)" has greatly changed the surgical paradigm of lung cancer. Previous studies revealed that excessive dissection of lymph nodes without metastases had uncertain clinical benefit. Meanwhile, it leads to the elevated risk of postoperative complications including chylothorax and laryngeal nerve injury. In addition, dissection of nonmetastatic lymph nodes may disturb systematic immunity, resulting in the secondary effect on primary tumor or latent metastases. The past decades have witnessed the innovative strategies such as lobe-specific lymph node dissection and selective lymph node dissection. On the basis of evolution of lymph node dissection strategy, we discuss the negative effects of excessive nonmetastatic lymph node dissection and summarize the recent advances in the optimized dissection strategies, hoping to provide unique perspectives on the future directions.
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Affiliation(s)
- Chenyu Jiang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yang Zhang
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Fangqiu Fu
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Penghao Deng
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Haiquan Chen
- Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Institute of Thoracic Oncology, Fudan University, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
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Xiao L, Yu S, Xu W, Sun Y, Xin J. 99mTc-3PRGD 2 SPECT/CT Imaging for Diagnosing Lymph Node Metastasis of Primary Malignant Lung Tumors. Korean J Radiol 2023; 24:1142-1150. [PMID: 37899523 PMCID: PMC10613846 DOI: 10.3348/kjr.2023.0411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/19/2023] [Accepted: 08/22/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To evaluate 99mtechnetium-three polyethylene glycol spacers-arginine-glycine-aspartic acid (99mTc-3PRGD2) single-photon emission computed tomography (SPECT)/computed tomography (CT) imaging for diagnosing lymph node metastasis of primary malignant lung neoplasms. MATERIALS AND METHODS We prospectively enrolled 26 patients with primary malignant lung tumors who underwent 99mTc-3PRGD2 SPECT/CT and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT imaging. Both imaging methods were analyzed in qualitative (visual dichotomous and 5-point grades for lymph nodes and lung tumors, respectively) and semi-quantitative (maximum tissue-to-background radioactive count) manners for the lymph nodes and lung tumors. The performance of the differentiation of lymph nodes with and without metastasis was determined at the per-lymph node station and per-patient levels using histopathological results as the reference standard. RESULTS Total 42 stations had metastatic lymph nodes and 136 stations had benign lymph nodes. The differences between metastatic and benign lymph nodes in the visual qualitative and semiquantitative analyses of 99mTc-3PRGD2 SPECT/CT and 18F-FDG PET/CT were statistically significant (all P < 0.001). The area under the receiver operating characteristic curve (AUC) in the semi-quantitative analysis of 99mTc-3PRGD2 SPECT/CT was 0.908 (95% confidence interval [CI], 0.851-0.966), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.86 (36/42), 0.88 (120/136), 0.69 (36/52), and 0.95 (120/126), respectively. Among the 26 patients (including two patients each with two lung tumors), 15 had pathologically confirmed lymph node metastasis. The difference between primary lung lesions in patients with and without lymph node metastasis was statistically significant only in the semi-quantitative analysis of 99mTc-3PRGD2 SPECT/CT (P = 0.007), with an AUC of 0.807 (95% CI, 0.641-0.974). CONCLUSION 99mTc-3PRGD2 SPECT/CT imaging may notably perform in the direct diagnosis of lymph node metastasis of primary malignant lung tumors and indirectly predict the presence of lymph node metastasis through uptake in the primary lesions.
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Affiliation(s)
- Liming Xiao
- Department of Nuclear Medicine, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Shupeng Yu
- Department of Nuclear Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weina Xu
- Department of Nuclear Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yishan Sun
- Department of Nuclear Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jun Xin
- Department of Nuclear Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
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Wang F, Yu X, Han Y, Zhang L, Liu S. Evaluation of the significance of subcarinal lymph node dissection in stage IB non‑small cell lung cancer. Mol Clin Oncol 2023; 18:50. [PMID: 37313447 PMCID: PMC10258657 DOI: 10.3892/mco.2023.2646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/25/2023] [Indexed: 06/15/2023] Open
Abstract
Lymph node dissection is used to treat early-stage lung cancer. The present study aimed to investigate if resecting the subcarinal lymph nodes affects prognosis of patients with stage IB non-small cell lung cancer (NSCLC). A total of 597 patients with stage IB NSCLC who underwent lung cancer surgery at Sun Yat-Sen University Cancer Center from January 1999 to December 2009 were included in the present study. The potential prognostic factors were evaluated using the Cox proportional hazard regression model. A total of 252 cases were obtained following propensity score matching (PSM). To compare overall survival (OS) and recurrence-free survival (RFS), Kaplan-Meier method and log-rank test were used. Among the 597 cases included, 185 did not undergo subcarinal lymph node resection, whereas 412 did. There were statistically significant differences between the two groups in terms of bronchial invasion, number of resected lymph node stations and resected lymph node numbers (P<0.05). Age, family history of cancer and the number of resected lymph nodes were prognostic factors for OS, whereas age and the number of resected lymph nodes were prognostic factors for RFS (P<0.05). Resection of subcarinal lymph nodes was not associated with OS and RFS. After PSM, survival analysis was recalculated using the Kaplan-Meier method and log-rank test; subcarinal lymph node resection was not statistically associated with OS and RFS. (P>0.05). For stage IB NSCLC, there was no statistically significant association between subcarinal lymph node resection and OS and RFS. Subcarinal lymph node resection in surgery of stage IB NSCLC may be considered optional.
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Affiliation(s)
- Feng Wang
- Department of Minimally Invasive Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, P.R. China
| | - Xiangyang Yu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer, Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, Guangdong 518116, P.R. China
| | - Yi Han
- Department of Minimally Invasive Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, P.R. China
| | - Lanjun Zhang
- State Key Laboratory of Oncology in South China, Department of Thoracic Surgery, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Shuku Liu
- Department of Minimally Invasive Surgery, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing 101149, P.R. China
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Singh A, Jaklitsch MT. Lymph node sampling-what are the numbers? J Surg Oncol 2023; 127:308-318. [PMID: 36630092 DOI: 10.1002/jso.27157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/05/2022] [Accepted: 11/11/2022] [Indexed: 01/12/2023]
Abstract
Lung cancer is a deadly disease. Lymph node staging is the most important prognostic factor, and lymphatic drainage of the lung is complex. Major advances have been made in this field over the last several decades, but there is much left to understand and improve upon. Herein, we review the history of the lymphatic system and the creation of lymph node maps, the evolution of tumor, node, and metastasis lung cancer classification, the importance of lung cancer staging, techniques for lymph node dissection, and our recommendations regarding a minimum number of nodes to sample during pulmonary resection.
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Affiliation(s)
- Anupama Singh
- Division of Thoracic Surgery, Harvard Medical School Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Harvard Medical School Brigham and Women's Hospital, Boston, Massachusetts, USA
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Liu J, Zhang X, Li J. Uniportal VATS lobectomy versus thoracotomy lobectomy for NSCLC larger than 5 cm: A propensity score-matched study. Thorac Cancer 2022; 14:489-496. [PMID: 36564867 PMCID: PMC9925343 DOI: 10.1111/1759-7714.14771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The performance of uniportal VATS lobectomy (uVATS) for non-small cell lung cancer (NSCLC) larger than 5 cm is uncertain due to a lack of evidence. Here, we present a retrospective, propensity-score matched cohort study to evaluate the safety and effectiveness of uVATS for patients with locally advanced NSCLC. METHODS The data of patients with NSCLC larger than 5 cm diameter who underwent curative resection via uVATS or thoracotomy lobectomy between January 2015 and December 2020 was collected. Propensity-score matching was utilized to control the observable biases. RESULTS Seventy-two patients underwent uVATS lobectomy, while 38 received thoracotomy lobectomy. No conversion to open surgery or perioperative death occurred. uVATS lobectomy achieved similar total lymph node dissection counts compared to thoracotomy and even yielded a higher amount of lymph node dissection in pTNM stage II patients. The long-term overall and recurrence-free survival rates were also similar between the two groups. Results from the propensity-score matching generated cohort agreed with those from the full cohort. CONCLUSIONS uVATS lobectomy is feasible and effective for curative lobectomy for NSCLC larger than 5 cm in diameter in selected patients. Further validations from well-designed prospective studies are required for uVATS lobectomy for patients with locally advanced NSCLC.
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Affiliation(s)
- Jingwei Liu
- Peking University First Hospital, Department of Thoracic SurgeryPeking University Health Science CenterBeijingChina
| | - Xining Zhang
- Peking University First Hospital, Department of Thoracic SurgeryPeking University Health Science CenterBeijingChina
| | - Jian Li
- Peking University First Hospital, Department of Thoracic SurgeryPeking University Health Science CenterBeijingChina
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Zhou Y, Du J, Ma C, Zhao F, Li H, Ping G, Wang W, Luo J, Chen L, Zhang K, Zhang S. Mathematical models for intraoperative prediction of metastasis to regional lymph nodes in patients with clinical stage I non-small cell lung cancer. Medicine (Baltimore) 2022; 101:e30362. [PMID: 36281188 PMCID: PMC9592279 DOI: 10.1097/md.0000000000030362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
It remains challenging to determine the regions of metastasis to lymph nodes during operation for clinical stage I non-small cell lung cancer (NSCLC). This study aimed to establish intraoperative mathematical models with nomograms for predicting the hilar-intrapulmonary node metastasis (HNM) and the mediastinal node metastasis (MNM) in patients with clinical stage I NSCLC. The clinicopathological variables of 585 patients in a derivation cohort who underwent thoracoscopic lobectomy with complete lymph node dissection were retrospectively analyzed for their association with the HNM or the MNM. After analyzing the variables, we developed multivariable logistic models with nomograms to estimate the risk of lymph node metastasis in different regions. The predictive efficacy was then validated in a validation cohort of 418 patients. It was confirmed that carcinoembryonic antigen (>5.75 ng/mL), CYFRA211 (>2.85 ng/mL), the maximum diameter of tumor (>2.75 cm), tumor differentiation (grade III), bronchial mucosa and cartilage invasion, and vascular invasion were predictors of HNM, and carcinoembryonic antigen (>8.25 ng/mL), CYFRA211 (>2.95 ng/mL), the maximum diameter of tumor (>2.75 cm), tumor differentiation (grade III), bronchial mucosa and cartilage invasion, vascular invasion, and visceral pleural invasion were predictors of MNM. The validation of the prediction models based on the above results demonstrated good discriminatory power. Our predictive models are helpful in the decision-making process of specific therapeutic strategies for the regional lymph node metastasis in patients with clinical stage I NSCLC.
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Affiliation(s)
- Yue Zhou
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Junjie Du
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Changhui Ma
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei Zhao
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai Li
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guoqiang Ping
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Wang
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jinhua Luo
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Chen
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Zhang
- Pancreas Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shijiang Zhang
- Department of Thoracic and Cardiovascular Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Shijiang Zhang, No. 300 Guangzhou Road, Nanjing 210029, China (e-mail: )
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Zhang Y, Zhang Y, Cheng X, Dai K, Xu B, Liang S, Chen M, Zhang H, Chen Z. The Prognostic Impact of Lymph Node Dissection on Primary Tumor Resection for Stage IV Non-Small Cell Lung Cancer: A Population-Based Study. Front Oncol 2022; 12:853257. [PMID: 35600401 PMCID: PMC9117632 DOI: 10.3389/fonc.2022.853257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/05/2022] [Indexed: 01/19/2023] Open
Abstract
Objective Selected patients with stage IV non–small cell lung cancer (NSCLC) who underwent primary tumor resection have witnessed a survival benefit. Whether additional lymph node dissection (LND) would result in a better effect remain unknown. We investigated the prognostic impact of LND on patients with stage IV NSCLC who received primary tumor resection (PTR). Methods Patients with stage IV NSCLC who underwent PTR were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2016. Propensity-score matching was performed to minimize the confounding effect, and lung cancer-specific survival (CSS) and overall survival (OS) were compared after matching. Multivariable Cox regression was used to identify prognostic factors and to adjust for covariates in subgroup analysis. The effect of the number of lymph nodes examined on the CSS was evaluated by repeating the Cox analysis in a binary method. Results A total of 4,114 patients with stage IV NSCLC who receive surgery met our criteria, of which 2,622 (63.73%) underwent LND and 628 patients were identified 1:1 in LND and non-LND groups after matching. Compared with the non-LND group, the LND group had a longer CSS (median: 23 vs. 16 months, p < 0.001) and OS (median: 21 vs. 15 months, p < 0.001). Multivariable regression showed that LND was independently associated with favorable CCS [hazard ratio (HR) = 0.78, 95% confidence interval (CI) 0.69–0.89, P < 0.001] and OS (HR = 0.79, 95% CI 0.70–0.89, P < 0.001). Subgroup analysis suggested that LND is an independent favorable predictor to survival in the surgical patients who were older age (>60 years old), female, T3-4, N0, and M1a stage and those who underwent sublobar resection. In addition, a statistically significant CCS benefit was associated with an increasing number of lymph nodes examined through 25 lymph nodes. Conclusions LND with a certain range of lymph nodes number examined was associated with improved survival for patients with stage IV NSCLC who received primary tumor resection. The results may have implications for guidelines on lymph nodes management in selective advanced NSCLC for surgery.
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Affiliation(s)
- Yudong Zhang
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yichi Zhang
- Department of Thoracic Surgery and Oncology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinxin Cheng
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Keyao Dai
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Bo Xu
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shujun Liang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Minsheng Chen
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Honglang Zhang
- Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Zhenguang Chen
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Cardiothoracic Surgery of East Division, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Lymph Node Dissection Is a Risk Factor for Short-Term Cough after Pulmonary Resection. Curr Oncol 2022; 29:294-307. [PMID: 35049701 PMCID: PMC8774379 DOI: 10.3390/curroncol29010027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 11/17/2022] Open
Abstract
Cough is a common complication after pulmonary resection. However, the factors associated with cough that develop after pulmonary resection are still controversial. In this study, we used the Simplified Cough Score (SCS) and the Leicester Cough Questionnaire (LCQ) score to investigate potential risk factors for postoperative cough. Between January 2017 and June 2021, we collected the clinical data of 517 patients, the SCS at three days after surgery and the LCQ at two weeks and six weeks after surgery. Then, univariate and multivariate analyses were used to identify the independent risk factors for postoperative cough. The clinical baseline data of the cough group and the non-cough group were similar. However, the cough group had longer operation time and more blood loss. The patients who underwent lobectomy were more likely to develop postoperative cough than the patients who underwent segmentectomy and wedge resection, while the patients who underwent systematic lymph node dissection were more likely to develop postoperative cough than the patients who underwent lymph node sampling and those who did not undergo lymph node resection. When the same lymph node management method was applied, there was no difference in the LCQ scores between the patients who underwent wedge resection, lobectomy and segmentectomy. The lymph node resection method was an independent risk factor for postoperative cough (p < 0.001). Conclusions: Lymph node resection is an independent risk factor for short-term cough after pulmonary resection with video-assisted thoracoscopic surgery, and damage to the vagus nerve and its branches (particularly the pulmonary branches) is a possible cause of short-term cough. The mechanism of postoperative cough remains to be further studied.
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Rezzola S, Sigmund EC, Halin C, Ronca R. The lymphatic vasculature: An active and dynamic player in cancer progression. Med Res Rev 2021; 42:576-614. [PMID: 34486138 PMCID: PMC9291933 DOI: 10.1002/med.21855] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/29/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022]
Abstract
The lymphatic vasculature has been widely described and explored for its key functions in fluid homeostasis and in the organization and modulation of the immune response. Besides transporting immune cells, lymphatic vessels play relevant roles in tumor growth and tumor cell dissemination. Cancer cells that have invaded into afferent lymphatics are propagated to tumor‐draining lymph nodes (LNs), which represent an important hub for metastatic cell arrest and growth, immune modulation, and secondary dissemination to distant sites. In recent years many studies have reported new mechanisms by which the lymphatic vasculature affects cancer progression, ranging from induction of lymphangiogenesis to metastatic niche preconditioning or immune modulation. In this review, we provide an up‐to‐date description of lymphatic organization and function in peripheral tissues and in LNs and the changes induced to this system by tumor growth and progression. We will specifically focus on the reported interactions that occur between tumor cells and lymphatic endothelial cells (LECs), as well as on interactions between immune cells and LECs, both in the tumor microenvironment and in tumor‐draining LNs. Moreover, the most recent prognostic and therapeutic implications of lymphatics in cancer will be reported and discussed in light of the new immune‐modulatory roles that have been ascribed to LECs.
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Affiliation(s)
- Sara Rezzola
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Elena C Sigmund
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Cornelia Halin
- Institute of Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - Roberto Ronca
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
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Haruki T, Takagi Y, Kubouchi Y, Kidokoro Y, Nakanishi A, Nozaka Y, Oshima Y, Matsui S, Nakamura H. Comparison between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery for mediastinal and hilar lymph node dissection in lung cancer surgery. Interact Cardiovasc Thorac Surg 2021; 33:409-417. [PMID: 34297835 DOI: 10.1093/icvts/ivab112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/01/2021] [Accepted: 03/26/2021] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Lymph node dissection (LND) with robot-assisted thoracoscopic surgery (RATS) in lung cancer surgery has not been fully evaluated. The aim of this study was to compare LND surgical results between video-assisted thoracoscopic surgery (VATS) and RATS. METHODS We retrospectively compared perioperative parameters, including the incidence of LND-associated complications (chylothorax, recurrent and/or phrenic nerve paralysis and bronchopleural fistula), lymph node (LN) counts and postoperative locoregional recurrence, among 390 patients with primary lung cancer who underwent lobectomy and mediastinal LND by RATS (n = 104) or VATS (n = 286) at our institution. RESULTS The median total dissected LN numbers significantly differed between the RATS and the VATS groups (RATS: 18, VATS: 15; P < 0.001). They also significantly differed in right upper zone and hilar (#2R + #4R + #10L) (RATS: 12, VATS: 10; P = 0.002), left lower paratracheal and hilar (#4L + #10L) (RATS: 4, VATS: 3; P = 0.019), aortopulmonary zone (#5 + #6) (RATS: 3, VATS: 2; P = 0.001) and interlobar and lobar (#11 + #12) LNs (RATS: 7, VATS: 6; P = 0.041). The groups did not significantly differ in overall nodal upstaging (P = 0.64), total blood loss (P = 0.69) or incidence of LND-associated complications (P = 0.77). CONCLUSIONS In this comparison, it was suggested that more LNs could be dissected using RATS than VATS, especially in bilateral superior mediastinum and hilar regions. Accumulation of more cases and longer observation periods are needed to verify whether RATS can provide the acceptable quality of LND and local control of lung cancer.
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Affiliation(s)
- Tomohiro Haruki
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yuzo Takagi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yasuaki Kubouchi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yoshiteru Kidokoro
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Atsuyuki Nakanishi
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yuji Nozaka
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yuki Oshima
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Shinji Matsui
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hiroshige Nakamura
- Department of Surgery, Division of General Thoracic Surgery, Faculty of Medicine, Tottori University, Tottori, Japan
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Wang R, Deng HY, Zhou J, Jiang R, Zhou Q. Surgical Consideration Based on Lymph Nodes Spread Patterns in Patients with Peripheral Right Middle Non-small Cell Lung Cancer 3 cm or Less. World J Surg 2021; 44:3530-3536. [PMID: 32548710 DOI: 10.1007/s00268-020-05647-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The optimal extent of lung resection and lymph nodes dissection for peripheral early-stage right middle non-small cell lung cancer (NSCLC) still remains controversial. In this study, we analyzed the patterns of lymph nodes metastasis (LNM) of patients with peripheral right middle NSCLC ≤ 3 cm, aiming to provide evidences for surgical choice for early-stage peripheral right middle lobe NSCLC. METHODS We retrospectively investigated the clinical and pathological data of patients diagnosed with peripheral right middle lobe NSCLC ≤ 3 cm between January 2015 and December 2019. The LNM patterns were analyzed by tumor size. RESULTS A total of 60 patients were included for analysis. The tumor size was preoperatively divided as follows: ≤ 1 cm (13 patients); > 1 cm but ≤ 2 cm (36 patients); > 2 cm but ≤ 3 cm (11 patients). Fifty-four patients were categorized as N0 group, 1 patient as N1 group, and 5 patients as N2 group. In the upper zone, 3 patients were found to have LNM. In the subcarinal zone, another 3 patients had LNM. But the lymph nodes of all these patients were negative in the lower zone. In station 10, 1 patient (1.67%) was found to have LNM, while in station 11-13, 2 patients (3.33%) were found to have LNM. CONCLUSION For the right middle lobe peripheral NSCLC ≤ 1 cm, sublobar resection with lymph node sampling may be a feasible treatment. For cancers > 1 cm but ≤ 2 cm, lobectomy with lobe-specific lymph node dissection (especially station 2R and 4R) may be a preferred choice. For tumors > 2 cm but ≤ 3 cm, lobectomy with systematic lymph node dissection may still be the standard of care.
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Affiliation(s)
- Rulan Wang
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Han-Yu Deng
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China.
| | - Jie Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Rui Jiang
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People's Republic of China.
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12
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Tumor volume is more reliable to predict nodal metastasis in non-small cell lung cancer of 3.0 cm or less in the greatest tumor diameter. World J Surg Oncol 2020; 18:168. [PMID: 32669129 PMCID: PMC7364500 DOI: 10.1186/s12957-020-01946-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/03/2020] [Indexed: 01/08/2023] Open
Abstract
Background In this study, we sought to evaluate the correlation between TV, GTD, and lymph node metastases in NSCLC patients with tumors of GTD ≤ 3.0 cm. Methods We retrospectively analyzed the characteristics of clinicopathologic variables for lymph node involvement in 285 NSCLC patients with tumors of GTD ≤ 3.0 cm who accepted curative surgical resection. The TVs were semi-automatically measured by a software, and optimal cutoff points were obtained using the X-tile software. The relationship between GTD and TV were described using non-linear regression. The correlation between GTD, TV, and N stages was analyzed using the Pearson correlation coefficient. The one-way ANOVA was used to compare the GTD and TV of different lymph node stage groups. Results The relationship between GTD and TV accorded with the exponential growth model: y = 0.113e1.455x (y = TV, x = GTD). TV for patients with node metastases (4.78 cm3) was significantly greater than those without metastases (3.57 cm3) (P < 0.001). However, there were no obvious GTD differences in cases with or without lymph node metastases (P = 0.054). We divided all cases into three TV groups using the two cutoff values (0.9 cm3 and 3.9 cm3), and there was an obvious difference in the lymphatic involvement rate between the groups (P < 0.001). The tendency to metastasize was greater with higher TV especially when the TV was > 0.9–14.2 cm3 (P = 0.010). Conclusions For NSCLC tumors with GTD ≤ 3.0 cm, TV is a more sensitive marker than GTD in predicting the positive lymph node metastases. The likelihood for metastasis increases with an increasing TV especially when GTD is > 2.0–3.0 cm.
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Pani E, Kennedy G, Zheng X, Ukert B, Jarrar D, Gaughan C, Pechet T, Kucharczuk J, Singhal S. Factors associated with nodal metastasis in 2-centimeter or less non-small cell lung cancer. J Thorac Cardiovasc Surg 2019; 159:1088-1096.e1. [PMID: 31610968 DOI: 10.1016/j.jtcvs.2019.07.089] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 06/25/2019] [Accepted: 07/11/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Lymph node involvement is an important determinant of treatment and prognosis in non-small cell lung cancer (NSCLC) and must be determined via surgical lymph node (LN) evaluation. However, lymphadenectomy is associated with multiple significant morbidities. Recent studies have suggested LN evaluation can be foregone in some or all patients with NSCLC ≤2.0 cm. Our objective was to identify whether these patients may be safely spared the morbidity of lymphadenectomy. METHODS We undertook a retrospective study of patients treated for NSCLC ≤2.0 cm at a single institution from 2005 to 2017. We examined patient, demographic, and tumor variables for associations with LN metastases via univariable and multivariable analyses. RESULTS In total, 555 patients met our inclusion criteria. Our primary independent variables included tumor size, histology, and histologic subtype. Although tumors ≤1 cm were less likely to have LN metastases than 1.1- to 2-cm tumors (6.8% vs 13.3%), there was no statistically significant difference. Histologic type was not associated with LN status. In an adenocarcinoma subgroup analysis, micropapillary predominant tumors were more likely to have LN metastases. All invasive mucinous adenocarcinomas and minimally invasive adenocarcinomas were N0. CONCLUSIONS LN evaluation may be unnecessary in patients with minimally invasive adenocarcinoma or invasive mucinous adenocarcinomas ≤2.0 cm. However, this information is rarely available pre- or intraoperatively. Thus, we recommend LN evaluation always be performed when possible, even for subcentimeter NSCLC, unless the histology is absolutely certain. To our knowledge, this is the largest dataset published to study patients with NSCLC ≤2.0 cm.
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Affiliation(s)
- Ethan Pani
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Gregory Kennedy
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Xin Zheng
- Department of Pediatrics, Children's Hospital of British Columbia, Vancouver, British Columbia, Canada
| | - Benjamin Ukert
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa
| | - Doraid Jarrar
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Colleen Gaughan
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Taine Pechet
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - John Kucharczuk
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Sunil Singhal
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pa.
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14
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Moulla Y, Gradistanac T, Wittekind C, Eichfeld U, Gockel I, Dietrich A. Predictive risk factors for lymph node metastasis in patients with resected non-small cell lung cancer: a case control study. J Cardiothorac Surg 2019; 14:11. [PMID: 30651112 PMCID: PMC6335711 DOI: 10.1186/s13019-019-0831-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Estimation of lymph node status is essential in order to determine precise therapy for patients with non-small cell lung cancer (NSCLC). Furthermore, lymph node involvement is a very powerful prognostic factor in these patients. In this analysis, we aim to evaluate the predictive factors for lymph node metastasis in NSCLC-patients. Methods In a prospectively-established database, we analyzed all data of patients with NSCLC, who underwent oncological surgical resections from 01/2007 to 12/2016, retrospectively. The correlation between clinicopathological parameters and lymph node metastasis was investigated by using univariate and binary logistic regression analysis. Results In this study, we operated on 204 consecutive patients, 142 men (71.7%) and 56 women (28.3%). Lymph node metastases were detected in 38.2% (78/204). Preoperatively, central tumor localization (OR = 2.6, 95% CI = 1.3–5.1, P = 0.005) and tumor size > 3 cm (OR = 2.5, 95% CI = 1.3–4.4, P = 0.005) were found to be significant predictive factors for lymph node metastasis. Postoperatively, multivariate analysis showed that intratumoral lymph vessel invasion (L1-status) (OR = 17.3, 95% CI = 5.1–58.4, P < 0.001) along with the central tumor localization (OR = 2.8, 95% CI = 1.4–5.8, P = 0.004) were significantly associated with lymph node metastasis. In small size tumors (≤3 cm), two predictive factors for lymph node metastasis were found: central tumor localization (OR = 19.4, 95% = 2.1–186.4, P = 0.01) and L1-status (OR = 43.9, 95% CI = 3.6–529.4, P = 0.003). Conclusions A precise pre- and intraoperative assessment of the lymph node status is essential in patients with larger sized tumors and central localization. Furthermore, L1-status is a highly significant risk factor for lymph node metastasis in NSCLC-Patients. Therefore, an adjuvant therapy in patients with L1-status and pNX category should be considered.
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Affiliation(s)
- Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Tanja Gradistanac
- Institute of Pathology, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Christian Wittekind
- Institute of Pathology, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Uwe Eichfeld
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Arne Dietrich
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Zhang D, Chen X, Zhu D, Qin C, Dong J, Qiu X, Fan M, Zhuo Q, Tang X. Intrapulmonary lymph node metastasis is common in clinically staged IA adenocarcinoma of the lung. Thorac Cancer 2018; 10:123-127. [PMID: 30468025 PMCID: PMC6360232 DOI: 10.1111/1759-7714.12908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intrapulmonary lymph nodes (LNs, stations 11-14) are usually omitted in postoperative pathological examination. Some non-small cell lung cancer (NSCLC) patients with intrapulmonary LN metastasis are incorrectly diagnosed as N0 cases. Furthermore, underestimation of intrapulmonary LN involvement in clinically early stage NSCLC may lead to the incorrect choice of surgical procedure: lobectomy or sublobar resection. This study was conducted to determine the status of intrapulmonary LN involvement in clinically staged IA (c-T1N0M0) peripheral adenocarcinoma of the lung. METHODS Seventy-five lobectomy specimens of c-T1N0M0 peripheral adenocarcinoma of the lung were carefully dissected to find intrapulmonary LNs. The longest diameter of each intrapulmonary LN was measured and sent for pathological examination, together with hilar and mediastinal LNs, to investigate the relationship between LN metastasis and primary tumor size. RESULTS Intrapulmonary LN metastasis was detected in 22.7%(17/75) of patients. Positive LNs were detected in 21.7% (10/46) of T1b patients and 45% (11/24) of T1c patients, while no metastasis (0/5) was observed in T1a patients (P = 0.036). The mean longest diameter of the 17 involved intrapulmonary LNs was only 6.5 ± 2.1 mm, which was not significantly different to the size of negative intrapulmonary LNs (5.2 ± 1.4 mm). CONCLUSIONS Intrapulmonary LN metastasis is common in clinically staged IA peripheral adenocarcinoma of the lung. LN metastasis is related to tumor size, and this should be taken into account to determine appropriate surgical procedures and postoperative treatment. Computed tomography is not a reliable method to judge LN metastasis, particularly intrapulmonary LN metastasis.
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Affiliation(s)
- DengGuo Zhang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Thoracic Surgery, The Affiliated University Hospital, Southern West Medical University, Luzhou, Sichuan, China
| | - XianChao Chen
- Department of Thoracic Surgery, The Affiliated University Hospital, Southern West Medical University, Luzhou, Sichuan, China
| | - Daxin Zhu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Changlong Qin
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingsi Dong
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoming Qiu
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingyu Fan
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - QingHua Zhuo
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - XiaoJun Tang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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16
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Huang L, Zheng B, Chen C, Zheng W, Zhu Y, Guo C. [To Explore Clinical Value of Single-port Video-assisted Thoracoscopic Surgery
in Elderly Patients with Non-small Cell Lung Cancer: Lobectomy, Segmentectomy
and Lobectomy vs Segmentectomy]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:287-295. [PMID: 29587908 PMCID: PMC5973339 DOI: 10.3779/j.issn.1009-3419.2018.04.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
背景与目的 肺癌的发病率长期位于癌症之首。Ⅰ期、Ⅱ期和部分Ⅲ期非小细胞肺癌(non-small cell lung cancer, NSCLC)的主要治疗方式以手术为主,肺叶切除术与肺段切除术为两类较为常见的手术方式。电视辅助胸腔镜手术(video-assisted thoracoscopic surgery, VATS)已广泛应用于临床,单孔电视辅助胸腔镜(single-port video-assisted thoracoscopic surgery, SP VATS)在胸部外科手术中的应用也逐渐被国内外专家所认识和接受。随着社会高龄化程度逐渐加深,这类患者成为NSCLC诊疗的难点。本研究探讨并分析SP VATS肺叶切除术与肺段切除术在治疗高龄NSCLC患者中的临床应用价值。 方法 回顾性分析福建医科大学附属协和医院胸外科在2014年5月-2016年12月期间行SP VATS肺叶切除与肺段切除的417例患者资料。其中高龄患者139例(肺叶切除124例vs肺段切除15例),非高龄患者278例(肺叶切除248例vs肺段切除30例)。分别比较高龄与非高龄患者行SPVATS肺叶或肺段切除术及高龄患者行肺叶、肺段切除术的围手术期及术后短期恢复情况。 结果 SP VATS肺叶切除和肺段切除的比较组中,除在术前合并症患病率上,高龄患者均高于非高龄患者(P < 0.05),在其余比较项上无明显差异(P > 0.05)。在单孔胸腔镜肺叶切除和肺段切除的高龄患者比较中,可发现淋巴结清扫站数[(7.61±0.21)组vs (5.60±0.35)组]及数目[(20.39±0.97)枚vs(15.40±2.64)枚],差异有统计学意义(P < 0.05),而在年龄、术前合并症患病率、平均手术时间、术中失血量却无统计学差异(P > 0.05)。虽然在术后并发症发生率上肺叶切除和肺段切除的高龄患者无统计学差异(P > 0.05),但是在术后房颤和双下肢静脉血栓发生率上却存在明显差异(P < 0.05)。在术后住院时间[(3.18±1.32)天vs (5.04±1.30)天]、胸管放置时间[(7.00±1.31)天vs (5.00±0.74)天]及总住院费用[(70.06±5.23)千元vs (61.20±5.22)千元]上,差异无统计学意义(P > 0.05)。 结论 高龄患者由于合并更多基础疾病,可能增加术后并发症的风险,但单孔胸腔镜肺叶及肺段切除术并不增加高龄患者的手术相关风险,且对合适的高龄病例行肺段切除可获得与肺叶切除相类似的短期疗效。
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Affiliation(s)
- Lin Huang
- Department of Thoracic Surgery, Fujian Medical University Affiliated Union Hospital, Fuzhou 350001, China
| | - Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Affiliated Union Hospital, Fuzhou 350001, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Affiliated Union Hospital, Fuzhou 350001, China
| | - Wei Zheng
- Department of Thoracic Surgery, Fujian Medical University Affiliated Union Hospital, Fuzhou 350001, China
| | - Yong Zhu
- Department of Thoracic Surgery, Fujian Medical University Affiliated Union Hospital, Fuzhou 350001, China
| | - Chaohui Guo
- Department of Thoracic Surgery, Fujian Medical University Affiliated Union Hospital, Fuzhou 350001, China
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Li W, Yang XN, Liao RQ, Nie Q, Dong S, Zhai HR, Wu YL, Zhong WZ. Intraoperative frozen sections of the regional lymph nodes contribute to surgical decision-making in non-small cell lung cancer patients. J Thorac Dis 2016; 8:1974-80. [PMID: 27621849 DOI: 10.21037/jtd.2016.06.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Individualization of pulmonary parenchymal resection and lymphadenectomy in lung cancer patients will likely become more important as surgical innovation. This study explored the utility of intraoperative pathological frozen sections of regional lymph nodes in non-small cell lung cancer (NSCLC) patients. METHODS Patients with NSCLC underwent intraoperative sampling of N1 station lymph nodes depending on the location of the tumor, any other suspicious lymph nodes were also biopsied. The contribution of frozen-section analysis to surgical decision-making was evaluated. RESULTS Of 74 lung cancer patients who underwent intraoperative frozen section analysis of lymph nodes, the positive rate was 18/74 (24.3%). The extents of agreement between preoperative N staging (cN) and intraoperative N staging (sN), cN staging and postoperative N staging (pN), and sN staging and pN staging were 62.2% (46/74), 63.5% (47/74), and 71.6% (53/74), respectively. When frozen section was combined with evaluation of pulmonary function and intrathoracic adhesions, surgical strategies were modified during operations in 18 cases (5 sN-positive, 13 sN-negative). Of these patients, five underwent extensive pulmonary parenchymal resection, and four had conservative lung parenchymal resection. In nine patients, the extent of lymph node dissection (LND) was changed. CONCLUSIONS Intraoperative frozen section of regional lymph nodes led to 24.3% operative strategies modification in lung cancer. Frozen section analysis may make an important contribution to surgical decision-making in terms of pulmonary parenchymal resection and LND.
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Affiliation(s)
- Wei Li
- Southern Medical University, Guangzhou 510515, China;; Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ri-Qiang Liao
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Qiang Nie
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Song Dong
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Hao-Ran Zhai
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Lin Y, Zheng W, Zhu Y, Guo Z, Zheng B, Chen C. Comparison of treatment outcomes between single-port video-assisted thoracoscopic anatomic segmentectomy and lobectomy for non-small cell lung cancer of early-stage: a retrospective observational study. J Thorac Dis 2016; 8:1290-6. [PMID: 27293849 DOI: 10.21037/jtd.2016.04.65] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There are few reports of single-port video-assisted thoracoscopic surgery (S-VATS) anatomic segmentectomy and S-VATS lobectomy for early-stage non-small cell lung cancer (NSCLC) and no comparisons between them have yet been reported. Therefore, the aim of this study was to compare the safety and efficacy of S-VATS anatomic segmentectomy and S-VATS lobectomy for early-stage NSCLC. METHODS In this retrospective observational study, the outcomes of 79 consecutive patients who had undergone S-VATS anatomic segmentectomy (32 patients) or S-VATS lobectomy (47 patients) for early-stage NSCLC from April 2014 to June 2015 were examined. The operation time, intraoperative blood loss, numbers of dissected lymph nodes and mediastinal nodal stations, numbers of staples used, postoperative drainage volume and duration, duration of hospital stay, costs, postoperative complications, local recurrence, and survival were compared between these two groups. RESULTS The postoperative drainage volume was smaller and the postoperative drainage duration shorter in the S-VATS segmentectomy than the lobectomy group (P<0.05). There were no significant differences in operation time, intraoperative blood loss, number of staples used, number and stations of dissected mediastinal lymph nodes, duration of hospital stay, costs, or postoperative complications. At the time of writing, no deaths or local recurrences had occurred in either group. CONCLUSIONS S-VATS segmentectomy is as safe and effective as S-VATS lobectomy. Patients who undergo S-VATS segmentectomy seem to recover faster.
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Affiliation(s)
- Yuxing Lin
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Wei Zheng
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Yong Zhu
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Zhaohui Guo
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Bin Zheng
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Chun Chen
- Thoracic Department, Fujian Medical University Union Hospital, Fuzhou 350001, China
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Yoshiya T, Miyata Y, Ibuki Y, Mimae T, Tsutani Y, Nakayama H, Okumura S, Yoshimura M, Okada M. The Difference in Maximum Standardized Uptake Value among Lung Adenocarcinomas Located at the Upper and Lower Zone on PET/CT. Respiration 2015; 90:293-8. [DOI: 10.1159/000437096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 06/16/2015] [Indexed: 11/19/2022] Open
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