A narrative review on lymphadenectomy: from open to minimally invasive surgery

Aprile, Vittorio; Ceccarelli, Ilaria; Korasidis, Stylianos; Mastromarino, Maria Giovanna; Bacchin, Diana; Sicolo, Elisa; Ambrogi, Marcello Carlo; Lucchi, Marco

doi:10.21037/vats-21-33

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…It is reported that when it comes to minimally invasive surgery, conversion is usually forced by calcified lymph nodes (11), but in our group there was no conversion for U-RATS and for the two cases of M-RATS conversion, this was needed for bleeding control and tactical purposes. None of these cases were related to the learning curve or the experience of the surgeons and were independent of the number of ports.…”

Section: Conversionmentioning

confidence: 54%

Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience

Manolache¹,

Motaş²,

Bosinceanu³

et al. 2023

Ann Cardiothorac Surg

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Section: Conversionmentioning

confidence: 54%

Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience

Manolache¹,

Motaş²,

Bosinceanu³

et al. 2023

Ann Cardiothorac Surg

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“…Minimally invasive approaches to lymphadenectomy can achieve outcomes comparable to open surgery in terms of safety, feasibility, and effectiveness, particularly for the treatment of early-stage NSCLC. This implies that minimally invasive techniques can be considered viable alternatives to open surgery for lymphadenectomy ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…Comparison of overall survival of patients undergoing wedge resection or lobectomies (p = 0.39). (14).…”

Section: Discussionmentioning

confidence: 99%

Real-world survival outcomes of wedge resection versus lobectomy for cT1a/b cN0 cM0 non-small cell lung cancer: a single center retrospective analysis

Bertolaccini,

Cara,

Chiari

et al. 2023

Front. Oncol.

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BackgroundJCOG0802/WJOG4607L showed benefits in overall survival (OS) of segmentectomy. CALGB 140503 confirmed that sublobar resection was not inferior to lobectomy concerning recurrence-free survival (RFS) but did not provide specific OS and RFS according to the techniques of sublobar resections. Hence, we retrospectively analyze the survival differences between wedge resection and lobectomies for stage IA lung cancer.MethodsWe reviewed the clinical records of patients with clinical stage IA NSCLC over 20 years. The inclusion criteria were: preoperative staging with CT scan and whole body CT/PET; tumor size <20 mm; wedge resections or lobectomies with or without lymph node dissection; NSCLC as the only primary tumor during the follow-up period. We excluded: multiple invasive lung cancer; positive resection margin; preoperative evidence of nodal disease; distant metastasis at presentation; follow-up time <5 years. The reverse Kaplan – Meier method estimated the median OS and PFS and compared them by the log-rank test. The stratified backward stepwise Cox regression model was employed for multivariable survival analyses.Results539 patients were identified: 476 (88.3%) lobectomies and 63 (11.7%) wedge resections. The median OS time for the whole cohort was 189.7 months (range: 173.7 – 213.9 months). The 5-year wedge resection and lobectomy OS were 82.2% and 87.0%. The 5-year RFS of wedge resection and lobectomy were 17.8% and 28.9%. The log-rank test showed no significant differences (p = 0.39) between wedge resections and lobectomies regarding OS and RFS (p = 0.23).ConclusionsLobectomy and wedge resection are equivalent oncologic treatments for individuals with cN0/cM0 stage IA NSCLC <20 mm. Validating the current findings requires a prospective, randomized comparison between wedge resection and standard lobectomy to establish the prognostic significance of wedge resection.

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“…Improving LNI assessment would open interesting perspectives, especially in early-stage NSCLC. For resectable tumors, as thoracotomy is progressively supplanted by mini-invasive approaches, such as video-assisted thoracic surgery ( 8 ), it would help to solve the dilemma of lymphadenectomy extension ( 8 ) and secures the decision whether to perform postoperative chemotherapy. For unresectable tumors, it would allow better planning of radiotherapy and possible adjuvant treatments.…”

Section: Introductionmentioning

confidence: 99%

18F-FDG primary tumor uptake to improve N status prediction in cT1 non-metastatic non-small cell lung cancer: development and validation of a positron emission tomography model

et al. 2023

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Purpose:Occult lymph node involvement is a major issue in the management of non-small cell lung carcinoma (NSCLC), with an estimated prevalence of approximately 2.9–21.6% in 18F-FDG PET/CT series. The aim of the study is to construct a PET model to improve lymph node assessment.Methods:Patients with a non-metastatic cT1 NSCLC were retrospectively included from two centers, one used to constitute the training set, the other for the validation set. The best multivariate model based on Akaike’s information criterion was selected, considering age, sex, visual assessment of lymph node (cN0 status), lymph node SUVmax, primary tumor location, tumor size, and tumoral SUVmax (T_SUVmax). A threshold minimizing false pN0 prediction was chosen. This model was then applied to the validation set.Results:In total, 162 patients were included (training set: 44, validation set: 118). A model combining cN0 status and T_SUVmax was selected (AUC 0.907, specificity at threshold: 88.2%). In the validation cohort, this model resulted in an AUC of 0.832 and a specificity of 92.3% versus 65.4% for visual interpretation alone (p = 0.02). A total of two false N0 predictions were noted (1 pN1 and 1 pN2).Conclusion:Primary tumor SUVmax improves N status prediction and could allow a better selection of patients who are candidates for minimally invasive approaches.

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A narrative review on lymphadenectomy: from open to minimally invasive surgery

Cited by 4 publications

References 9 publications

Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience

Comparison of uniportal robotic-assisted thoracic surgery pulmonary anatomic resections with multiport robotic-assisted thoracic surgery: a multicenter study of the European experience

Real-world survival outcomes of wedge resection versus lobectomy for cT1a/b cN0 cM0 non-small cell lung cancer: a single center retrospective analysis

18F-FDG primary tumor uptake to improve N status prediction in cT1 non-metastatic non-small cell lung cancer: development and validation of a positron emission tomography model

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