Effect of mediastinal lymph nodes sampling in patients with clinical stage I non-small cell lung cancer

Abstract

:Objective : Systematic nodal dissection has been recommended for patients with resectable non-small cell lung cancer because of its staging accuracy. However, in patients with clinical stage I non-small cell lung cancer whether systematic nodal dissection provides more benefits than mediastinal lymph node sampling or not is controversial. In this retrospective study, we evaluated the effect of mediastinal lymph node sampling in patients with clinical stage I NSCLC. Methods : One hundred and nineteen consecutive patients with clinical stage I NSCLC, who underwent curative operation between January 1994 and December 2000, were retrospectively reviewed (dissection group = 58 : sampling group= 61). Systematic nodal dissection was defined as complete removal of mediastinal lymph node, and mediastinal lymph node sampling was defined as removal of lymph node levels 3, 4, and 7 for right-sided tumors and levels 5, 6, and 7 for left-sided tumors. Results : The total number of removed mediastinal lymph nodes in patients who underwent systematic nodal dissection was 22.1 9.7, which was significantly higher than that in patients who underwent mediastinal lymph node sampling of 11.4 7.0 (p 0.001). Postoperatively N2 disease was detected in 8 patients (13.8% %) in the dissection group and 7 (11.5% %) in the sampling group. After the median follow up of 79 months, the cancer specific survival rate at 5 year was 78.0% % in the dissection group and 76.2% % in the sampling group (p = 0.60). Conclusions : Mediastinal lymph node sampling showed the similar effect to systematic nodal dissection in patients with clinical stage I non-small cell lung cancer. J. Med. Invest. 55 : 37-43, February, 2008

Comparison of lobe-specific mediastinal lymphadenectomy versus systematic mediastinal lymphadenectomy for clinical stage T 1a N 0 M 0 non-small cell lung cancer

“…Some scholars have even advocated a localized segmentectomy or a wedge resection instead of the standard lobectomy plus lymph node dissection for cases with high GGO. [11] In addition, our study also found that the closer the tumor lied to the hilum, the easier mediastinal lymph node metastasis occurs. In our opinion, as there is no patient can be absolutely excluded the presence of N2 currently, a sentinel frozen biopsy can be conducted during the operation of T1a NSCLC.…”

“…Therefore, lobe-specific dissection can be a better choice for lymph node dissection for T1a NSCLC. [4,11] In addition, our study showed that the cases with high proportion of GGO had no recurrence and the prognosis is good during the five years' follow-up. A further analysis of the cases in SL group showed that none of the 16 cases with high proportion of GGO had mediastinal lymph node metastases.…”

“…This result might be because of the shortness of cases, but it was similar to previous reports. [11,12] In HRCT, the present of GGO mostly indicated the probability of focal alveolar cell carcinoma. [13] Some studies showed that the increase of BAC component in adenocarcinoma may indicate a better prognosis.…”

Sampling versus systematic full lymphatic dissection in surgical treatment of non-small cell lung cancer

“…The study of Takizawa and colleagues failed to prove any significant difference in overall survival between the MLND and the MLNS groups in 119 patients with clinical stage I NSCLC. 22 After the median follow up of 79 months, the survival rate was 78% in the MLND group and 76.2% in the MLNS group (P=0.6).…”

Factors on nodal up-staging in clinical N0 adenocarcinoma patients who had minimally invasive anatomic lung resections

“…Anatomic lung resections with systematic lymph node dissection have become the recommended treatment for early stage nonsmall lung cancer (NSCLC) [1] . Many investigators and clinicians recommend systematic nodal dissection to all lung cancer patients except those with clinical stage I disease [2] .…”