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

Toker, Alper; Özyurtkan, Mehmet Oğuzhan; Kaba, Erkan

doi:10.21037/jovs.2017.04.05

Cited by 12 publications

(15 citation statements)

References 28 publications

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“…In addition, nodal upstaging depends on the characteristic of primary neoplasm; in fact, the dimension of the tumour > 2 cm, clinical T stage > 1, central tumour, localisation in lower lobe and PET with SUV max value > 4 are to be considered risk factors [5] . The role of histology is debated, given that Decaluwé et al [6] described an association between squamous cell histology and nodal upstaging, whereas Toker identified the adenocarcinoma as a risk factor for upstaging.…”

Section: Nodal Upstaging In Nsclcmentioning

confidence: 99%

“…The role of histology is debated, given that Decaluwé et al [6] described an association between squamous cell histology and nodal upstaging, whereas Toker identified the adenocarcinoma as a risk factor for upstaging. Furthermore, Toker recognised the possible influence of some diseases, such as diabetes mellitus, rheumatoid arthritis and tuberculosis, on nodal upstaging [5] .…”

Section: Nodal Upstaging In Nsclcmentioning

confidence: 99%

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Nodal upstaging robotic lobectomy for non-small cell lung cancer

Zirafa¹,

Romano²,

Nesti³

et al. 2020

MIS

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Nodal upstaging takes place when unsuspected lymph node metastases are detected by pathological evaluation, after surgical treatment for non-small cell lung cancer. In early stages non-small cell lung cancer, nodal upstaging amounts to 4.8%-24.6%, depending on several factors, such as accuracy of preoperative staging, localisation and size of tumour and number of lymph nodes removed. Nodal upstaging is considered a surrogate of the completeness of thoracic oncologic surgery; for this reason, various studies focus on the evaluation of its rate in the different surgical approaches used to treat lung cancer. In this analysis, a high percentage of upstaging is observed in robotic surgery, having similar values to open surgery results, usually considered the gold standard in terms of oncologic radicality. In fact, thanks to its features, robotic surgery allows carrying out a thorough lymphadenectomy in the most comfortable manner, ensuring an excellent vision and manoeuvrability of the instruments even in the most remote areas of the thorax. According to these results, robotic surgery constitutes a safe and radical surgical option, showing encouraging results on the efficacy of lymphadenectomy and, consequently, on its the long-term outcomes.

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Section: Nodal Upstaging In Nsclcmentioning

confidence: 99%

Section: Nodal Upstaging In Nsclcmentioning

confidence: 99%

Nodal upstaging robotic lobectomy for non-small cell lung cancer

Zirafa¹,

Romano²,

Nesti³

et al. 2020

MIS

View full text Add to dashboard Cite

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“…However, a critical issue is the clinical implication of the total number of dissected lymph nodes. Nodal upstaging after surgery for lung cancer can be defined as the presence of unsuspected pathologic hilar (pN1) or mediastinal (pN2) disease detected during the final pathologic examination of surgical specimens [23]. According to the Cancer and Leukemia Group B prospective clinical trial (CALGB 9761), the incidence of nodal upstaging is 28% in clinical stage I lung cancer, 14% in stage II, and 14% in stage III [24].…”

Section: Kjtcvsmentioning

confidence: 99%

“…Many researchers have explored risk factors for nodal upstaging, including those pertaining to patients (such as diabetes mellitus, history of tuberculosis, and connective tissue disorders) and to tumor-related factors (such as central location, higher T stage, higher standardized uptake value, and histotype) [23,26]. We did so as well and found that only tumor-related factors (namely serum CEA levels, lesion size, and tissue-confirmed pleural invasion) heightened the risk of nodal upstaging.…”

Section: Kjtcvsmentioning

confidence: 99%

Nodal Outcomes of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Clinical Stage I Lung Cancer

Choi

Lee

Moon

et al. 2020

Korean J Thorac Cardiovasc Surg

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Background: Accurate intraoperative assessment of mediastinal lymph nodes is a critical aspect of lung cancer surgery. The efficacy and potential for upstaging implicit in these dissections must therefore be revisited in the current era of uniportal video-assisted thoracoscopic surgery (VATS). Methods: A retrospective study was conducted in which 544 patients with stage I (T1abc-T2a, N0, M0) primary lung cancer were analyzed. To assess risk factors for nodal upstaging and to limit any imbalance imposed by surgical choices, we constructed an inverse probability of treatment-weighted (IPTW) logistic regression model (in addition to non-weighted logistic models). We also evaluated risk factors for early locoregional recurrence using IPTW logistic regression analysis. Results: In the comparison of uniportal and multiportal VATS, the resected lymph node count (14.03±8.02 vs. 14.41±7.41, respectively; p=0.48) and rate of nodal upstaging (6.5% vs. 8.7%, respectively; p=0.51) appeared similar. Predictors of nodal upstaging included tumor size (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.12-2.70), carcinoembryonic antigen level (OR, 1.11; 95% CI, 1.04-1.18), and histologically confirmed pleural invasion (OR, 3.97; 95% CI, 1.89-8.34). The risk factors for locoregional recurrence within 1 year were found to be number of resected N2 nodes, age, and nodal upstaging. Conclusion: Uniportal and multiportal VATS appear similar with regard to accuracy and thoroughness, showing no significant difference in the extent of nodal dissection.

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“…Nodal upstaging in patients with NSCLC is defined as the unexpected pathological finding of metastasis in hilar (pN1) or mediastinal (pN2) lymph nodes in patients who were presumed to have clinical cN0 or cN1 at pre-operative staging exams (2). Therefore, the incidence of nodal upstaging is considered a quality criterion of completeness of lymphadenectomy.…”

Section: Introductionmentioning

confidence: 99%

Lymph node upstaging for non-small cell lung cancer after uniportal video-assisted thoracoscopy

Ismail¹,

Nachira²,

Swierzy³

et al. 2018

J. Thorac. Dis

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Background: Radical lymph node dissection (LND) plays a major role in the treatment of non-small cell lung cancer (NSCLC). This study presents the analysis of the results after uniportal video-assisted thoracoscopy (VATS) lymphadenectomy during anatomical lung resections for NSCLC, focusing on pathological nodal upstaging. Any possible risk factor affecting nodal upstaging was also investigated. Methods: The prospectively collected clinical data of 136 patients undergone uniportal VATS anatomical lung resections, from June 2012 to September 2017, were reviewed. In particular, all details inherent the clinical and pathological node stage and any possible risk factor affecting nodal upstaging were analyzed. Results: The patient population consisted of 90 males and 46 females; their mean age was 67.42±10.64 years. The mean number of lymph nodes retrieved during uniportal VATS lymphadenectomy was 20.14±10.73 (7.27±5.90 and 12.60±7.96 in N1 and N2 stations, respectively). The incidence of nodal upstaging was 13.3% (18 cases). In particular there was a N0-1 upstaging in 10 cases (7.4%), a N1-2 upstaging in 3 (2.2%) and a N0-2 in 4 (3%). The ROC analysis showed that the resection of 18 lymph nodes was the best predictor of a general upstaging with an AUC-ROC of 0.595, while the resection of 7 hilar lymph nodes was the best predictor of N1 upstaging (AUC-ROC: 0.554) and 11 mediastinal nodes was the best predictor of N2 upstaging (AUC-ROC: 0.671). The number of positive lymph nodes of stations 5-6 (OR: 2.035, 95% CI: 1.082-3.826, P=0.027) and stations 2-3-4 (OR: 6.198, 95% CI: 1.580-24.321, P=0.009) were confirmed to be the only independent risk factors for N2 upstaging by multivariate analysis. Conclusions: According to our experience, uniportal VATS allows a safe and effective radical lymphadenectomy, with a satisfactory pathological nodal upstaging, comparable to other minimally invasive techniques.

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

Cited by 12 publications

References 28 publications

Nodal upstaging robotic lobectomy for non-small cell lung cancer

Nodal upstaging robotic lobectomy for non-small cell lung cancer

Nodal Outcomes of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Clinical Stage I Lung Cancer

Lymph node upstaging for non-small cell lung cancer after uniportal video-assisted thoracoscopy

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