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

Toker, Alper; Özyurtkan, Mehmet Oğuzhan; Demirhan, Özkan; Ayalp, Kemal; Kaba, Erkan; Uyumaz, Elena

doi:10.5761/atcs.oa.16-00087

Cited by 48 publications

(43 citation statements)

References 19 publications

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“…The number of positive and total number of dissected lymph nodes were higher in the RATS compared to the VATS groups (P = 0.06, P < 0.05, respectively). These results were compatible with those of previous studies from our department [27] . We believed that RATS increases the capability of mediastinal dissection.…”

Section: Discussionsupporting

confidence: 94%

“…N1-level lymph nodes, and stations 10 and 11 for lobectomies, and additionally, station 12 were dissected completely and separately during segmentectomies. For segmentectomy, stations 11 and 12 nodes were dissected completely and evaluated by frozen section analysis [10] . If either of them was positive, we preferred to perform lobectomy instead of segmentectomy.…”

Section: Lymph Node Dissectionmentioning

confidence: 99%

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

Cosgun¹,

Kaba²,

Ayalp³

et al. 2019

MIS

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Aim: The incidence of adenocarcinoma among lung cancer patients has increased in recent years. We identified the factors affecting lymph node status in patients with primary lung adenocarcinoma who underwent minimallyinvasive anatomic resection. Methods: We retrospectively analyzed the medical records of primary lung adenocarcinoma patients who underwent minimally-invasive anatomic lung resections and mediastinal lymph node dissection between January 2012 and December 2017. We evaluated lymph node positivity and nodal status in each T and histologic subgroup, tumoral prognostic characteristics, minimally-invasive surgical methods and resection type. Results: Of 473 patients who underwent anatomic resection for lung cancer between January 2012 and December 2017, 274 underwent minimally-invasive anatomic lung resections for primary lung cancer, 158 adenocarcinoma patients were analyzed in this study. Nodal status and number of positive lymph nodes were similar in the stages T1, T2, T3. Lymphovascular invasion (n : 78) and micropapillary predominance tended to be significant predisposing factors for lymph node metastasis. Mean dissected lymph node number was significantly higher in patients who underwent Robot-assisted thoracoscopic surgery compared to Video-assisted thoracoscopic surgery (P < 0.05), and in those who underwent lobectomy compared to segmentectomy (P < 0.05). Conclusion: We were unable to demonstrate a relationship between T stage and N status. Factors contributing to unexpected N positivity were tumor characteristics that could not be identified in the preoperative period. We recommend performing systematic mediastinal lymph node dissection regardless of the size and histopathologic type of adenocarcinoma. In our study, robotic surgery and lobectomy operation showed superiority in dissecting more lymph nodes.

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Section: Discussionsupporting

confidence: 94%

Section: Lymph Node Dissectionmentioning

confidence: 99%

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

Cosgun¹,

Kaba²,

Ayalp³

et al. 2019

MIS

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“…In our recent study comparing three approaches (thoracotomy vs. VATS vs. RATS), we demonstrated that RATS could yield more peribronchial (number 11 and 12) compared to the other two techniques (24). We believe that this higher rate of interlobar lymph node dissection is due to our preference in performing segmentectomy operations more often which increases the number of dissected level 11 and 12 nodes.…”

Section: Theoretical Superiorities Of Robotic Surgery and Its Possiblmentioning

confidence: 86%

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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“…This change in surgical approach has raised three questions concerning the feasibility of systematic nodal dissection by videothoracoscopic approach, the prognostic impact of systematic nodal dissection and sampling, and their complications. Regarding the feasibility of systematic nodal dissection performed by videothoracoscopy, recent reports show that it can be performed whether videothoracoscopy is performed with three, two or one ports, or with a robot [127][128][129][130][131].…”

Section: Intrathoracic Staging At Pulmonary Resectionmentioning

confidence: 99%

Lung cancer staging: a concise update

et al. 2018

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Diagnosis and clinical staging of lung cancer are fundamental to planning therapy. The techniques for clinical staging, anatomic and metabolic imaging, endoscopies and minimally invasive surgical procedures, should be performed sequentially and with an increasing degree of invasiveness. Intraoperative staging, assessing the magnitude of the primary tumour, the involved structures, and the loco-regional lymphatic spread by means of systematic nodal dissection, is essential in order to achieve a complete resection. In resected tumours, pathological staging, with the systematic study of the resected specimens, is the strongest prognostic indicator and is essential to make further decisions on therapy. In the present decade, the guidelines on lung cancer staging of the American College of Chest Physicians and the European Society of Thoracic Surgeons are based on the best available evidence and are widely followed. Recent advances in the classification of the adenocarcinoma of the lung, with the definition of adenocarcinoma , minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma, and the publication of the eighth edition of the tumour, node and metastasis classification of lung cancer, have to be integrated into the staging process. The present review complements the latest guidelines on lung cancer staging by providing an update of all these issues.

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

Cited by 48 publications

References 19 publications

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

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

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

Lung cancer staging: a concise update

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