Alternative paratracheal lymph node dissection in left-sided hilar lung cancer patients: comparing the number of lymph nodes dissected to the number of lymph nodes dissected in right-sided mediastinal dissections

Toker, Alper; Tanju, Serhan; Ziyade, Sedat; Kaya, Serkan; Erus, Suat; Özkan, Berker; Yılmazbayhan, Dilek

doi:10.1016/j.ejcts.2010.09.013

Cited by 9 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study showed that a median of 12 nodes in the right and 11 nodes in the left chest have been resected from the mediastinum in healthy subjects; however, literature concerning mediastinal nodal dissection reveals discrepancy, creating a real confusion for chest surgeons. Excised number of mediastinal nodes with SND have been presented to be 17.3 nodes [3], 38.9 nodes (bilateral mediastinal dissection with transcervical technique, excluding station 9) [8], 40.3 in the right vs. 37.1 in the left (including hilar resion and stations 11 and 12) [9], 8.6 nodes (with video assisted mediastinoscopic lymphadenectomy (VAMLA) from paratracheal stations and station 7 [10], 16 nodes with VAMLA [11], and 8.4 nodes from paratracheal region only via left thoracotomy [12]. The presence of either micro metastasis, reaction to a tumor or to an infection in the lung distal to the tumor may be the reason for these discrepancies.…”

Section: Discussionmentioning

confidence: 99%

Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery

Ziyade

Pinarbasili

Ziyade

et al. 2013

J Cardiothorac Surg

Self Cite

View full text Add to dashboard Cite

BackgroundMediastinal lymph node dissection is an essential component of lung cancer surgery. Literature lacks established information regarding the number and size of the healthy lymph nodes. In this postmortem autopsy study, we aim to define the number, size and weight of the lymph nodes in each mediastinal lymph node station. To implement the data for the clinical practice, we analyzed the possible number of nodes to be dissected in a systematic mediastinal lymph node dissection from the right and left sides during lung cancer surgery.MethodsSixty-two samples obtained from cadavers who did not die from chest malignancies, extrathoracic malignancies, any kind of infections or previous hospitalization before the death were included to the study. The locations of the nodes were recorded according to the American Thoracic Society Mediastinal Lymph Node Map. The number, size and weight of the nodes were determined at each station.ResultsMedian age of the cadavers was 39 years. Primary causes of death were asphyxia in 10 (16.1%) subjects, trauma in 29 (46.8%) subjects, cardiovascular problems in 10 (16.1%) subjects, and undetermined in 13 (21%) subjects. The median number of lymph nodes resected from each patient was 23 (range: 11–54). The right sided paratracheal lymph nodes (Station 2R and 4R) were more frequent, heavier and longer than left sided lymph nodes (Station 2L and 4L) at the paratrecheal region. Right sided inferior mediastinal lymph nodes were heavier and longer than the left ones; however, their availability was more often on the left.ConclusionsThe properties of mediastinal lymph nodes at particular stations are different for number, size and weight. Station 4R and 7 have the highest number of nodes followed by stations 5 and 6. We recommend removing the lymph nodes of these stations completely in lung cancer patients to rule out the possibility of micrometastatic disease. Diameter of normal lymph node may be 1 cm for the stations other than 4R and 7, but the definition of normal diameter of a lymph node at the stations 4R and 7 may be changed as 1,5 cm and 2,0 cm, respectively. Weight of the nodes may be a new subject to study and may be defined as a new modality to define a staging to be more accurate and the issue needs further investigations.

show abstract

Section: Discussionmentioning

confidence: 99%

Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery

Ziyade

Pinarbasili

Ziyade

et al. 2013

J Cardiothorac Surg

Self Cite

View full text Add to dashboard Cite

show abstract

“…Lymph node counting was done as previously described. 16) Fissures were divided by staplers or coagulation in all resections. Basically, for a segmentectomy operation level 11 and 12 nodes were dissected completely and sent for frozen section analysis.…”

Section: Surgical Techniquementioning

confidence: 99%

Lymph Node Dissection in Surgery for Lung Cancer: Comparison of Open vs. Video-Assisted vs. Robotic-Assisted Approaches

Toker

Özyurtkan

Demirhan

et al. 2016

ATCS

Self Cite

View full text Add to dashboard Cite

“…For a right-sided NSCLC, paratracheal lymph nodes can be removed completely (Figure 1, Video 1). For left sided tumors, complete resection of paratracheal nodes may pose to be more challenging, but has been performed by several authors, including one of the authors of this manuscript (Figure 2, Video 2) (25). Bilateral paratracheal lymph node dissection has also been performed and presented for right and left sided tumors.…”

Section: Extent Of Lymph Node Dissectionmentioning

confidence: 99%

Evaluating the quality of lymphadenectomy in lung cancer resections: a narrative review

Kakuturu¹,

Abbas²,

Toker³

2022

AME Surg J

Self Cite

View full text Add to dashboard Cite

Objective: To review the current guidelines on intrathoracic lymph node assessment for lung cancer resections, examine current practice patterns, report survival differences with varying levels of lymph node dissection, and propose methods to improve quality of lymphadenectomy based on our experience.Background: Assessment of hilar and mediastinal lymph nodes at the time of resection for lung cancer has been recognized as a key aspect of surgical treatment. Although the value of lymphadenectomy in lung cancer staging and treatment has been established, specific guidelines as to the number and location of lymph nodes considered to be adequate, vary among societies, institutions, and surgeons. Additionally, many lung resections fail to meet any of the proposed criteria for lymph node examination.Methods: To find relevant articles for the narrative review, the PubMed database was used to search for the following key terms and their combinations: "lymphadenectomy", "lymph node staging", "lung cancer", "NSCLC", "lung surgery", "lung resection", "lobectomy", "segmentectomy", "wedge resection", "quality", and "extent". A total of 33 articles were examined and publication years ranged from 1951 to 2021.Conclusions: Systematic mediastinal lymph node dissection is recommended in all type of surgeries for lung cancer, whether robotic surgery, video-assisted thoracoscopic surgery (VATS), or an open thoracotomy.There should be no difference in each technique as to the number of stations and quantity of lymph nodes examined, in order for lung cancer resection to be considered complete.

show abstract

Alternative paratracheal lymph node dissection in left-sided hilar lung cancer patients: comparing the number of lymph nodes dissected to the number of lymph nodes dissected in right-sided mediastinal dissections

Cited by 9 publications

References 19 publications

Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery

Determination of standard number, size and weight of mediastinal lymph nodes in postmortem examinations: reflection on lung cancer surgery

Lymph Node Dissection in Surgery for Lung Cancer: Comparison of Open vs. Video-Assisted vs. Robotic-Assisted Approaches

Evaluating the quality of lymphadenectomy in lung cancer resections: a narrative review

Contact Info

Product

Resources

About