Lobe-Specific Lymph Node Dissection as a Standard Procedure in Surgery for Non–Small Cell Lung Cancer: A Propensity Score Matching Study

Adachi, Hiroyuki; Sakamaki, Kentaro; Nishii, Teppei; Yamamoto, Taketsugu; Nagashima, Takuya; Ishikawa, Yoshihiro; Ando, Koji; Yamanaka, Kazuki; Watanabe, Katsuya; Kumakiri, Yutaka; Tsuboi, Masahiro; Maehara, Takamitsu; Nakayama, Haruhiko; Masuda, Munetaka

doi:10.1016/j.jtho.2016.08.127

Cited by 85 publications

(83 citation statements)

References 22 publications

(33 reference statements)

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“…We recently reported noninferiority of L-SND compared to SND for accuracy of staging and postoperative prognosis, using a PS matching method. Our results showed 5-year OS rates of 73.5% after L-SND and 75.3% after SND group, with no significant difference between the procedures, and a rate of occult pN2 of 8.2% for each procedure (14). Hishida et al assessed the outcomes of 5,392 patients after complete resection (lobectomy with SND or L-SND) for clinical stage I-II NSCLC using an inverse probability of treatment weighting-adjusted Cox model and found the impressive result that L-SND had a favorable impact on postoperative survival, compared with SND (hazard ratio =0.68, 95% confidence interval: 0.60-0.77) (15).…”

Section: Editorialmentioning

confidence: 49%

Mediastinal lymph node dissection in surgical treatment for early stage non-small-cell lung cancer: lobe-specific or systematic?

2017

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The standard surgical treatment for early stage non-smallcell lung cancer (NSCLC) is lobectomy or pneumonectomy with systematic lymph node dissection (SND) (1,2). In 2006, the European Society of Thoracic Surgeons (ESTS) released guidelines for intraoperative lymph node staging in NSCLC, in which intraoperative procedures for lymph nodes were classified into five groups; selected lymph node biopsy, (systematic) sampling, lobe-specific lymph node dissection (L-SND), SND, and extended lymph node dissection; and it was recommended to provide SND in all cases of complete resection of NSCLC (3). SND was first reported by Cahan in 1960 (4). This technique is designed to provide precise information on nodal status, which is necessary for optimal postoperative treatment, and to achieve better local cancer control that subsequently improves postoperative survival. However, the influence of SND on local control and survival remains uncertain, even though its value for accurate histologic staging of nodal status is well accepted. In addition, some reports have shown that SND tends to require longer operative times and to increase perioperative complications, compared to other procedures (5-7). Thus, many surgeons tend to avoid SND and perform "less invasive" intraoperative treatment for lymph nodes (8).Based on this background, L-SND has attracted attention as a procedure in which some nodal stations are left untouched and unresected depending on the lobar location of the primary tumor. L-SND is designed based on characteristic mediastinal nodal metastasis patterns that occur for different primary tumor locations. In 1998, Okada et al. showed the characteristic skip N2 metastasis pattern (9), and in 1999, Asamura et al. reported characteristic patterns based on the primary tumor location (10). According to their report, tumors in the RUL and LUL tend to metastasize to the superior mediastinal lymph node station, whereas single-station metastasis to the subcarinal node is very rare; while tumors in the RLL or LLL show metastases to the subcarinal node and to the superior mediastinal or aortic node (10). However, Asamura et al. concluded that subcarinal node metastasis was the touchstone of mediastinal spread of RLL and LLL tumors because singlenode or single-station metastases were more common in the subcarinal station and the prognosis of RLL or LLL tumors with both subcarinal and superior mediastinal lymph node metastases was extremely poor, even if SND was performed. Further, a specific lymphatic spread pattern was not identified for RML tumors (10).Comparing L-SND with SND from nodal staging Editorial

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Section: Editorialmentioning

confidence: 49%

Mediastinal lymph node dissection in surgical treatment for early stage non-small-cell lung cancer: lobe-specific or systematic?

2017

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“…Some retrospective studies have demonstrated SLND is an alternative to LND for selected clinical-stage I-II patients and has the potential to become a standard procedure in surgical treatment for NSCLC (11,33,34,36,37). Meanwhile, Izbicki (10) and Graham (38) argued that LND should be routinely operated for resectable NSCLC.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, Izbicki (10) and Graham (38) argued that LND should be routinely operated for resectable NSCLC. On one hand, whether LND would increase postoperative morbidity associated with complications is not clear (10,36) and the influence on outcome such as overall survival and diseasefree survival remains controversial (5,8,17,33,34). On the other hand, the reported benefit that SLND can shorten the entire medical period along with its validity, reliability and applicability are still not very clear.…”

Section: Discussionmentioning

confidence: 99%

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Selective lymph node dissection in early-stage non-small cell lung cancer

Han

Chen

2017

J. Thorac. Dis.

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Lymph node dissection is a vital part of surgical treatment in early-stage non-small cell lung cancer (NSCLC). Removal of metastatic lymph nodes while preservation of intact lymph nodes are equally important. For hospitalized early-stage patients with limited lymph node metastasis, the operation treatment should be made according to some rules such as lobe-specific lymph node drainage pattern. In order to prevent unnecessary surgical trauma in early-stage patients, a minimally invasive approach with selective lymph node excision is preferred for more clinical benefits. This review summarizes the existing findings on lobe-specific lymph node drainage pattern and we hope to provide guidance for selective lymph node dissection (SLND). Furthermore, we include information on histologic views, a tumor marker and protocols of SLND, with hope to inspire creative research and clinical trials in this field.

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“…In the era with advanced technology and instruments facilitating surgical procedure, the adverse event or complication resulting from MLNR could be avoided. As the only two studies comparing MLNR with no MLNR based on the surveillance, epidemiology, and end results program (SEER) data revealed the 5-year lung cancer survival rates for those with stage I disease and MLNR was 5% higher (21,22), performing MLNR would benefit the patients more when the complication rate reaches less than 5% (23). Besides, as preoperative 3D reconstruction is gradually available for pulmonary segmentectomy and even subsegmentectomy, overcoming the technical demand may facilitate limited, anatomical resection of the nodule, and specific lymph node resection, not only for individual patient but also for individual nodule.…”

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confidence: 99%

Surgery for mediastinal lymph node and early stage lung cancer: individualized practice based on clinical database

Yen

Tseng

2018

J. Thorac. Dis.

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Lobe-Specific Lymph Node Dissection as a Standard Procedure in Surgery for Non–Small Cell Lung Cancer: A Propensity Score Matching Study

Abstract: These results suggest that lobe-specific lymph node dissection has the potential to be a standard procedure in surgical treatment for NSCLC.

Cited by 85 publications

References 22 publications

Mediastinal lymph node dissection in surgical treatment for early stage non-small-cell lung cancer: lobe-specific or systematic?

Mediastinal lymph node dissection in surgical treatment for early stage non-small-cell lung cancer: lobe-specific or systematic?

Selective lymph node dissection in early-stage non-small cell lung cancer

Surgery for mediastinal lymph node and early stage lung cancer: individualized practice based on clinical database

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