A National Study of Nodal Upstaging After Thoracoscopic Versus Open Lobectomy for Clinical Stage I Lung Cancer

Licht, Peter B.; Jørgensen, Ole Dan; Ladegaard, Lars; Jakobsen, Erik

doi:10.1016/j.athoracsur.2013.04.011

Cited by 204 publications

(160 citation statements)

References 17 publications

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“…The rate of upward N stage migration in this series was 10.8%, which is slightly lower than published rates of RATS nodal upstaging of 13.2%. 15 Our rates were comparable to reported ranges of VATS nodal upstaging, reported to be 8.1%-15.2%, [15][16][17] and thoracotomy, report ed to be 11.5%-13.1%. 17 This series provides comparable results to the robotic literature and confirms the safety of robotic resection for pulmonary lobectomy.…”

Section: Discussionsupporting

confidence: 72%

Robotic-assisted thoracoscopic surgery for lung resection: the first Canadian series

Fahim

Hanna

Waddell

et al. 2017

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Background: Robotic surgery was introduced as a platform for minimally invasive lung resection in Canada in October 2011. We present the first Canadian series of robotic pulmonary resection for lung cancer.Methods: Prospective databases at 2 institutions were queried for patients who underwent robotic resection for lung cancer between October 2011 and June 2015.To examine the effect of learning curves on patient and process outcomes, data were organized into 3 temporal tertiles, stratified by surgeon.Results: A total of 167 consecutive patients were included in the study. Median age was 66 (range 27-88) years, and 46.1% (n = 77) of patients were men. The majority of patients (n = 141, 84%) underwent robotic lobectomy. Median duration of surgery was 270 (interquartile range [IQR] 233-326) minutes, and median length of stay (LOS) was 4 (IQR 3-6) days. Twelve patients (7%) were converted to thoracotomy. Total duration of surgery and console time decreased significantly (p < 0.001) across tertiles, with a steady decline until case 20, followed by a plateau effect. Across tertiles, there was no significant difference in LOS, number of lymph node stations removed, or perioperative complications. Conclusion:The results of this case series are comparable to those reported in the literature. A prospective study to examine the outcomes and cost of robotic pulmonary resection compared with video-assisted thoracoscopic surgery should be done in the context of the Canadian health care system. We have presented the first consecutive case series of robotic lobectomy in Canada. Outcomes compare favourably to other series in the literature.Contexte : C'est en octobre 2011 que la chirurgie robotisée a fait son entrée au Cana da comme approche à la résection pulmonaire minimalement effractive. Nous présentons à notre connaissance la première série canadienne sur la résection pulmonaire robotisée pour le cancer du poumon.Méthodes : Nous avons interrogé les bases de données prospectives de 2 établissements pour recenser les patients ayant subi une résection robotisée pour un cancer du poumon entre octobre 2011 et juin 2015. Nous avons organisé les données en 3 tertiles temporels et nous les avons stratifiées par chirurgien pour mesurer l'effet des courbes d'apprentissage sur les résultats enregistrés chez les patients et du point de vue des procédés.Résultats : En tout, 167 patients consécutifs ont été inclus dans l'étude. L'âge médian était de 66 ans (entre 27 et 88 ans) et 46,1 % (n = 77) étaient des hommes. La majorité des patients (n = 141, 84 %) ont subi une lobectomie robotisée. La durée moyenne des interventions a été de 270 minutes (intervalle interquartile [IIQ] 96) et la durée mé diane des séjours a été de 4 jours (IIQ 3). L'intervention s'est transformée en thoracotomie chez 12 patients (7 %). La durée totale de la chirurgie et le temps passé à la console ont diminué significativement (p < 0,001) selon les différents tertiles, avec un déclin constant jusqu'au cas no 20, suivi d'un effet de plateau. Entre les tertiles, on...

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Section: Discussionsupporting

confidence: 72%

Robotic-assisted thoracoscopic surgery for lung resection: the first Canadian series

Fahim

Hanna

Waddell

et al. 2017

cjs

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“…Nodal upstaging, defined as the finding of a higher N value on the final pathologic specimen compared to the preoperative clinical N, has been identified as a viable predictor of the adequacy of nodal management and, indirectly, as a surrogate for the identification of patients who are at risk of survival (12).…”

Section: Introductionmentioning

confidence: 99%

Nodal management and upstaging of disease: initial results from the Italian VATS Lobectomy Registry

Bertani¹,

Gonfiotti²,

Nosotti³

et al. 2017

J. Thorac. Dis.

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Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC.Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies.Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies.Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98].Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.

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“…As imaging did not identify the nodal metastases, nodal upstaging is likely dependent on the efficacy of the surgical lymph node evaluation. Therefore, the prevalence of nodal upstaging may be a landmark for the completeness of nodal evaluation (1,2). Incomplete staging might also happen since invasive staging of both hilar and peribronchial lymph nodes remains challenging with more recent techniques including endobronchial or endoscopic ultrasound (2).…”

Section: How Is Nodal Upstaging For Lung Cancer Defined?mentioning

confidence: 99%

“…Several studies have shown that VATS has less nodal upstaging than thoracotomy, suggesting a difference in the completeness of nodal evaluation. However, none has demonstrated a difference in overall or disease-free survival (2).…”

Section: Introductionmentioning

confidence: 99%

“…To define the oncologic equivalence, the prevalence of pathologic nodal upstaging is used as a quality measure for the definition of the completeness of the nodal dissection, and surgery by comparing video-assisted thoracoscopic surgery (VATS) and thoracotomy patients (1,2). Several studies have shown that VATS has less nodal upstaging than thoracotomy, suggesting a difference in the completeness of nodal evaluation.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nodal upstaging: effects of instrumentation and three-dimensional view in clinical stage I lung cancer

Toker

Özyurtkan²,

Kaba

2017

J. Vis. Surg.

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A National Study of Nodal Upstaging After Thoracoscopic Versus Open Lobectomy for Clinical Stage I Lung Cancer

Cited by 204 publications

References 17 publications

Robotic-assisted thoracoscopic surgery for lung resection: the first Canadian series

Robotic-assisted thoracoscopic surgery for lung resection: the first Canadian series

Nodal management and upstaging of disease: initial results from the Italian VATS Lobectomy Registry

Nodal upstaging: effects of instrumentation and three-dimensional view in clinical stage I lung cancer

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