Lymphatic Spread in Resectable Lung Cancer: Can We Trust in a Sentinel Lymph Node?

Abstract

The aim of this study was to describe lymphatic spread in resected lung cancer patients and evaluate for the presence for a reliable sentinel lymph node. Onethousand and eighty-eight patients with NSCLC underwent resection. Twelve to sixteen percent of the patients with primaries in the upper lobes had an involvement in the upper mediastinum; in 12 %, it was subcarinal, in 6 % and 3 %, in the lower mediastinum at paraoesophageal and ligamentum pulmonale sites, respectively. The rate of "lymph node skipping" is between 31 and 74 %. An isolated involvement of mediastinal nodes is possible without involvement of the N-1 position. Irrespective of the location of the primary tumour, there is a high incidence of "lymph node skipping" because of the specific architecture of the pulmonary, hilar and medistinal lymph nodes. Therefore, a reliable sentinel lymph node in lung cancer cannot be defined. In conclusion, systematic lymph node dissection in anatomical compartments is the gold standard for evaluation of the exact pN stage. Furthermore, a complete R/O-resection is a prognostically relevant factor in the surgery of NSCLC.

Short- and long-term outcome of sleeve resections in the elderly☆

“…The high number of dissected lymph nodes facilitates the correct postoperative staging and can lead to excellent local tumour control. Furthermore, there is still no sentinel lymph node in lung cancer [23]. As reported by Keller et al [24] complete nodal dissection is associated with better survival even in the event of N2 disease.…”

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

“…There is still no consensus in the field, but there has been a trend, at least among the European chest surgeons, toward performing a systematic node dissection or systematic sampling of the right side, including at least stations 2R-4R-7-8 and 9 [17]. The frequency of occurrence of skip metastasis and absence of a reliable sentinel lymph node in lung cancer could make systematic lymph node dissection in anatomical compartments as a standard procedure for the evaluation of the exact N stage [6]. However, more extensive dissection, including the contralateral and the cervical lymph nodes, has not been a common a practice in Europe and North America.…”

“…Subaortic, paraaortic, subcarinal, hilar, and interlobar lymph nodes (level [5][6][7][8][9][10][11] are resected in the standard manner. After complete removal of number 5 nodes, blunt dissection is performed toward the superior and contralateral mediastinum through an opening posterior to the left main pulmonary artery (LMPA) and anterosuperior to the left main bronchus (LMB).…”

“…It is clear that lymph node sampling is useful for staging and prognostic purposes. However, the optimal extent of lymph node dissection is controversial, and the benefits of systematic sampling versus complete mediastinal lymph node dissection or extended lymph node dissection are still under investigation [1][2][3][4][5][6]. A meta-analysis of three randomized trials found a significant survival benefit of dissection compared with sampling [5].…”

Pneumonektomie

“…Einen Sentinel-Lymphknoten gibt es beim Lungenkarzinom nicht [13,16]. Erst die systematische Lymphknotendissektion macht die Entstehung eines exakten pN-Stadiums möglich.…”