Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer

Maniwa, Tomohiro; Okumura, Takehiro; Isaka, Mitsuhiro; Nakagawa, Kazuo; Ohde, Yasuhisa; Kondo, Haruhiko

doi:10.1093/ejcts/ezt195

Cited by 63 publications

(52 citation statements)

References 22 publications

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“…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. Moreover, SLND was reported increasing the possibility of recurrence (35). In order to provide unambiguous answer, multi-institutional randomized clinical trials are expected to carry out in the future.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

Han

Chen

2017

J. Thorac. Dis.

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“…However, they did not investigate tumor recurrence. We also compared survival, morbidity, and the recurrence pattern between the clinico-surgical N0 NSCLC patients who underwent lobectomy with SND and LSD (17). When we excluded part-solid tumors with a small area of consolidation resulting in a consolidation/tumor ratio of <0.5 from the analysis, there were no significant differences in postoperative complication rates, 5-year overall and disease-free survival rates, or overall recurrence rates between SND and LSD groups.…”

Section: Editorialmentioning

confidence: 99%

“…Asamura (14) reported that tumors of the right lower lobe with superior mediastinal metastasis were associated with a poorer 5-year survival rate of 4.1%. Based on the results of the lobe-specific patterns of nodal metastases, lobe-specific nodal dissection (LSD) has been developed (15)(16)(17)(18).…”

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confidence: 99%

Has lobe-specific nodal dissection for early-stage non-small lung cancer already become standard treatment?

Maniwa

Kodama

2016

J. Thorac. Dis.

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“…Saeteng et al (13) reviewed 197 patients [including: RUL n=63 (31.98%), RLL n=30 (15.23%), LUL n=55 (27.92%), LLL n=16] and did not observe tumor location to be a precise predictor of the LN-metastasis pattern, rendering complete-MLND the only way to accurately determine LN status. Maniwa et al (14) confirmed that both superior and inferior mediastina were most frequently involved in case of multi-station pN2, a situation that was rarely diagnosed during work-up and commonly discovered by surgery. The recurrence of mediastinal LN cancer was significantly greater in patients undergoing "lobe-specific" LNdissection (LSLND) than in those undergoing complete-MLND (14).…”

mentioning

confidence: 96%

“…Maniwa et al (14) confirmed that both superior and inferior mediastina were most frequently involved in case of multi-station pN2, a situation that was rarely diagnosed during work-up and commonly discovered by surgery. The recurrence of mediastinal LN cancer was significantly greater in patients undergoing "lobe-specific" LNdissection (LSLND) than in those undergoing complete-MLND (14). They suggested that systematic complete-MLND was not only the option to accurately determine LN status but also a way to decrease the rate of mediastinal recurrence.…”

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confidence: 96%

From anatomy to lung cancer: questioning lobe-specific mediastinal lymphadenectomy reliability

et al. 2016

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The prognosis of non-small cell lung cancer (NSCLC) is improving (1-3). The standard treatment of early-stage, mainly lobectomy with systematic complete hilar and mediastinal lymphadenectomy (MLND) (4), is questioned nowadays. Minimal surgery or still less aggressive procedures are being advocated and gaining preference due to emergence and development of new technologies. In fact, diagnosis of NSCLC in early-stage is more frequent and clinical-staging more precise, with the risk of overlooking lymph node (LN) involvement and distant metastasis becoming regularly smaller. Thus, surgeons are attempting to define the minimal and suitable extents of lung resection and LN-dissection, a technique concerning the latter being recently revisited in the review (5).LN-involvement is effectively the keystone of long-term prognosis, and the quality of LN-dissection has always been a matter of debate. Complete-MLND permits the most curative resection by minimizing the risk of leaving tumor-LN behind and provides the most accurate pathological-TNM, which is crucial in adapting the best adjuvant therapy. Thus, complete-MLND is the gold standard. The reason of its relevance is demonstrated by anatomy and pathology studies.An anatomical study was conducted in adult cadavers to research whether lymphatic vessels (LV) directly draining into the mediastinal LN without crossing a n y i n t r a p u l m o n a r y L N c o u l d e x p l a i n s k i p p i n g metastases (6). Direct LVs into the mediastinal LN were observed in 54 right and 60 left lungs. Those direct LVs existed more often from the right and left upper lobes (RUL n=24 and LUL n=41) and mainly went into the upper mediastinum. However, there were three direct LVs from the RULs (12.5%) into the trachea-bronchial LN [LNstation 7 (7,8)] and one from the LULs (2.4%). Direct LVs were less frequent from the right and left lower lobes (RLL n=22 and LLL n=19) and mainly went into LN-station 7. However, nine from the RLL (41%) went into the right paratracheal LN 3, 4R (7,8) Another anatomical study including all the lymphatic drainages into the mediastinum and not only the direct ones (9), demonstrated that the RULs (n=99) had 20 LVs (20%) draining into the LN-station 7 and that the RLLs (n=178) had 87 LVs (48.9%) draining into the LN-station 2R, 3, and 4R. The LULs (n=178) had 25 LVs (14%) draining into the LN-station 7 and two (1.1%) into the LNs of the pulmonary ligament 8)]. The LLLs (n=166) had 99 LVs (59.6%) draining into the LNstation 4L and eight (4.8%) into the LN-station 5. Because of the high frequency of the lymphatic drainage from one lobe towards non-"lobe-specific" LN-stations in the mediastinum, anatomy logically supports recommending complete-MLND for NSCLC.In the same paper (9), the lymphatic drainage was compared with the tumoral involvement of the mediastinal LNs obtained by complete-MLND in 260 pN2-patients. 46 times and the LN station 2R, 3, and 4R involved in 15 (32.6%). The tumor was located in the LUL 68 times and the LN-station 7 involved in eight patients ...

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Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer

Abstract: The recurrence of mediastinal node cancer in patients undergoing L-SND was significantly greater than that in those undergoing SND.

Cited by 63 publications

References 22 publications

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

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

Has lobe-specific nodal dissection for early-stage non-small lung cancer already become standard treatment?

From anatomy to lung cancer: questioning lobe-specific mediastinal lymphadenectomy reliability

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