Mediastinal lymph node dissection: the debate is not resolved

Shayani, Jeffrey; Flores, Raja M.; Hakami, Ardeshir

doi:10.21037/jtd.2017.06.128

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…The reported nodal metastatic rate is 16% to 29% in early-stage NSCLC patients with a peripheral tumor 3 cm or less in diameter, 15% to 20% in patients with a peripheral tumor 2 cm or less 3 – 5 , and as low as 6.6% in clinical T 1a N 0 M 0 lung adenocarcinoma patients 6 . Considering the surgical injury, MLND is unnecessary and harmful to patients without mediastinal node involvement 2 , 7 , 8 . Correctly predicting pathologic node-negative (pN 0 ) disease in patients with NSCLC before operation may avoid unnecessary MLND, although it is an extremely difficult problem in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Pathologic N0 Status in Clinical T1N0M0 Lung Adenocarcinoma is Predictable by the Solid Component Proportion with Quantitative CT Number Analysis

Zhang

et al. 2017

Sci Rep

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Correctly predicting pathologic regional node-negative (pN0) disease in patients with lung cancer before operation may avoid unnecessary mediastinal lymph node dissection (MLND). In this study, we analyze the value of the radiographic and histopathological features of primary tumors for predicting pN0 status in cT1N0M0 lung adenocarcinoma and to establish an optimal surgical strategy for avoiding MLND in cT1N0M0 lung adenocarcinoma patients. We retrospectively investigated the histopathological and radiographic data of 348 surgically resected cT1N0M0 lung adenocarcinoma patients with systematic lymph node dissection from January 2005 to December 2012. Histopathological features and radiographic features were analyzed. Multivariable analysis was used to identify significant predictors of pN0 disease. Our results showed that pN0 disease was detected in 306 patients (87.9%) among the 348 patients with cT1N0M0 lung adenocarcinoma. A decreasing trend of the pN0 disease proportion was observed with both increasing histological grade and decreased differentiation (P < 0.001). In multivariable analysis, the solid component proportion was a significant predictor of pN0 disease. Among 110 patients with a solid component proportion of no more than 21.3%, mediastinal lymph node involvement was not observed. Patients who meet this criterion may be successfully managed with lung resection without MLND.

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Section: Introductionmentioning

confidence: 99%

Pathologic N0 Status in Clinical T1N0M0 Lung Adenocarcinoma is Predictable by the Solid Component Proportion with Quantitative CT Number Analysis

Zhang

et al. 2017

Sci Rep

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“…Mediastinal lymph node sampling versus dissection in the surgical staging of early non-small cell lung cancers (NSCLC) has been a controversial topic (1). In their manuscript "Extent of lymphadenectomy is associated with oncological efficacy of sublobar resection for lung cancer ≤2 cm," Stiles and colleagues (2) used data from the Surveillance, Epidemiology, and End Results (SEER) database to investigate whether the extent of lymph node dissection affects survival in patients undergoing segmentectomy or wedge resection for early NSCLC.…”

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confidence: 99%