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BMC Surgery
Published in: BMC Surgery 1/2015

Open Access 01-12-2015 | Technical advance

Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery

Authors: Chengwu Liu, Qiang Pu, Chenglin Guo, Zhilan Xiao, Jiandong Mei, Lin Ma, Yunke Zhu, Hu Liao, Lunxu Liu

Published in: BMC Surgery | Issue 1/2015

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Abstract

Background

This study aims to introduce an optimized method named “non-grasping en bloc mediastinal lymph node dissection (MLND)” through video-assisted thoracoscopic surgery (VATS).

Methods

Between February 2009 and July 2013, 402 patients with clinical stage I non-small cell lung cancer (NSCLC) underwent “non-grasping en bloc MLND” conducted by one surgical team. Target lymph nodes (LNs) were exposed following non-grasping strategy with simple combination of a metal endoscopic suction and an electrocoagulation hook or an ultrasound scalpel. In addition, dissection was performed following a stylized three-dimensional process according to the anatomic features of each station. Clinical and pathological data were prospectively collected and retrospectively reviewed.

Results

The postoperative morbidity and mortality were 17.4% (70/402) and 0.5% (2/402), respectively. The total number of LNs (N1 + N2) was 16.0 ± 5.9 (range of 5–52), while the number of N2 LNs was 9.5 ± 4.0 (range of 3–23). The incidences of postoperative upstaging from N0 to N1 and N2 disease were 7.7% and 12.2%, respectively.

Conclusions

Non-grasping en bloc MLND enables en bloc dissection of mediastinal LNs with comparable morbidity and oncological efficacy while saving troubles of excessive interference of instruments and potential damage to the target LN.
Literature
1.
Darling GE, Allen MS, Decker PA, Ballman K, Malthaner RA, Inculet RI, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg. 2011;141(3):662–70.CrossRefPubMedPubMedCentral
2.
Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol. 2007;2(8):706–14.CrossRefPubMed
3.
Ettinger DS, Akerley W, Bepler G, Blum MG, Chang A, Cheney RT, et al. Non-small cell lung cancer. J Nat Comprehensive Cancer Network: JNCCN. 2010;8(7):740–801.CrossRef
4.
Lardinois D, De Leyn P, Van Schil P, Porta RR, Waller D, Passlick B, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg. 2006;30(5):787–92.CrossRefPubMed
5.
Scott WJ, Allen MS, Darling G, Meyers B, Decker PA, Putnam JB, et al. Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg. 2010;139(4):976–81. discussion 981–973.CrossRefPubMed
6.
Scott WJ, Howington J, Feigenberg S, Movsas B, Pisters K. Treatment of non-small cell lung cancer stage I and stage II: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(3 Suppl):234S–42.CrossRefPubMed
7.
Sugi K, Kaneda Y, Esato K. Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer. World J Surg. 2000;24(1):27–30. discussion 30–21.CrossRefPubMed
8.
Sagawa M, Sato M, Sakurada A, Matsumura Y, Endo C, Handa M, et al. A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect? Ann Thorac Surg. 2002;73(3):900–4.CrossRefPubMed
9.
Watanabe A, Koyanagi T, Ohsawa H, Mawatari T, Nakashima S, Takahashi N, et al. Systematic node dissection by VATS is not inferior to that through an open thoracotomy: a comparative clinicopathologic retrospective study. Surgery. 2005;138(3):510–7.CrossRefPubMed
10.
Watanabe A, Mishina T, Ohori S, Koyanagi T, Nakashima S, Mawatari T, et al. Is video-assisted thoracoscopic surgery a feasible approach for clinical N0 and postoperatively pathological N2 non-small cell lung cancer? Eur J Cardiothorac Surg. 2008;33(5):812–8.CrossRefPubMed
11.
D’Amico TA, Niland J, Mamet R, Zornosa C, Dexter EU, Onaitis MW. Efficacy of mediastinal lymph node dissection during lobectomy for lung cancer by thoracoscopy and thoracotomy. Ann Thorac Surg. 2011;92(1):226–31. discussion 231–222.CrossRefPubMed
12.
Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol. 2009;27(15):2553–62.CrossRefPubMed
13.
Watanabe A, Nakazawa J, Miyajima M, Harada R, Nakashima S, Mawatari T, et al. Thoracoscopic mediastinal lymph node dissection for lung cancer. Semin Thorac Cardiovasc Surg. 2012;24(1):68–73.CrossRefPubMed
14.
Lee HS, Jang HJ. Thoracoscopic mediastinal lymph node dissection for lung cancer. Semin Thorac Cardiovasc Surg. 2012;24(2):131–41.CrossRefPubMed
15.
Amer K. Thoracoscopic mediastinal lymph node dissection for lung cancer. Semin Thorac Cardiovasc Surg. 2012;24(1):74–8.CrossRefPubMed
16.
Liu L, Che G, Pu Q, Ma L, Wu Y, Kan Q, et al. A new concept of endoscopic lung cancer resection: single-direction thoracoscopic lobectomy. Surg Oncol. 2010;19(2):e71–7.CrossRefPubMed
17.
Lardinois D, Suter H, Hakki H, Rousson V, Betticher D, Ris HB. Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg. 2005;80(1):268–74. discussion 274–265.CrossRefPubMed
18.
Izbicki JR, Passlick B, Pantel K, Pichlmeier U, Hosch SB, Karg O, et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg. 1998;227(1):138–44.CrossRefPubMedPubMedCentral
19.
Wu J, Ohta Y, Minato H, Tsunezuka Y, Oda M, Watanabe Y, et al. Nodal occult metastasis in patients with peripheral lung adenocarcinoma of 2.0 cm or less in diameter. Ann Thorac Surg. 2001;71(6):1772–7. discussion 1777–1778.CrossRefPubMed
20.
Doddoli C, Aragon A, Barlesi F, Chetaille B, Robitail S, Giudicelli R, et al. Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer? Eur J Cardiothorac Surg. 2005;27(4):680–5.CrossRefPubMed
21.
D’Amico TA. Videothoracoscopic mediastinal lymphadenectomy. Thorac Surg Clin. 2010;20(2):207–13.CrossRefPubMed
22.
Denlinger CE, Fernandez F, Meyers BF, Pratt W, Zoole JB, Patterson GA, et al. Lymph node evaluation in video-assisted thoracoscopic lobectomy versus lobectomy by thoracotomy. Ann Thorac Surg. 2010;89(6):1730–5. discussion 1736.CrossRefPubMed
23.
Wang H, D’Amico TA. Efficacy of mediastinal lymph node dissection during thoracoscopic lobectomy. Ann Cardiothorac Surg. 2012;1(1):27–32.PubMedPubMedCentral
24.
Khullar OV, Gangadharan SP. Video-assisted thoracoscopic mediastinal lymph node dissection. J Thorac Cardiovasc Surg. 2012;144(3):S32–4.CrossRefPubMed
Metadata
Title
Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery
Authors
Chengwu Liu
Qiang Pu
Chenglin Guo
Zhilan Xiao
Jiandong Mei
Lin Ma
Yunke Zhu
Hu Liao
Lunxu Liu
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2015
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-015-0025-1

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