Upfront surgery in patients with clinical skip N2 lung cancer based on results of modern radiological examinations

Maniwa, Tomohiro; Shintani, Yasushi; Okami, Jiro; Kadota, Yoshihisa; Takeuchi, Yukiyasu; Takami, Koji; Yokouchi, Hideoki; Kurokawa, Eiji; Kanzaki, Ryu; Sakamaki, Yasushi; Shiono, Hiroshi; Iwasaki, Teruo; Nishioka, Kiyonori; Kodama, Ken; Okumura, Meinoshin

doi:10.21037/jtd.2018.10.115

Cited by 12 publications

(16 citation statements)

References 33 publications

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“…The stage III cohort generally consisted of multiple histological types with a majority of squamous cell carcinoma and adenocarcinoma patients, except for 2 studies which consisted solely of adenocarcinoma [17] or squamous cell carcinoma [51] patients and 10 studies in which histological type was not reported specifically for stage III patients [14,31,33,35,39,74] or at all [20,50,64,70]. Stage III patients were treated exclusively with chemotherapy and/or radiotherapy in 39 studies [11-13,15,18,20,21,31,32,34-36,41,45,47,48 ,51,53-56,58-60,64,65,67,70-72,74,76,77,80-85], while surgery was an option in 25 publications [14,16,17,33,[37][38][39][40][42][43][44]46,49,50,52,57,[61][62][63]66,68,73,75,78,79]. A single study did not report treatment modalities [69].…”

Section: Resultsmentioning

confidence: 99%

Prognostic factors for overall survival of stage III non-small cell lung cancer patients on computed tomography: A systematic review and meta-analysis

Laar

Amsterdam

Lindert

et al. 2020

Radiotherapy and Oncology

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Introduction: Prognosis prediction is central in treatment decision making and quality of life for nonsmall cell lung cancer (NSCLC) patients. However, conventional computed tomography (CT) related prognostic factors may not apply to the challenging stage III NSCLC group. The aim of this systematic review was therefore to identify and evaluate CT-related prognostic factors for overall survival (OS) of stage III NSCLC. Methods: The Medline, Embase, and Cochrane electronic databases were searched. After study selection, risk of bias was estimated for the included studies. Meta-analysis of univariate results was performed when sufficient data were available. Results: 1595 of the 11,996 retrieved records were selected for full text review, leading to inclusion of 65 studies that reported data of 144,513 stage III NSCLC patients andcompromising 26 unique CT-related prognostic factors. Relevance and validity varied substantially, few studies had low relevance and validity. Only four studies evaluated the added value of new prognostic factors compared with recognized clinical factors. Included studies suggested gross tumor volume (meta-analysis: HR = 1.22, 95%CI: 1.05-1.42), tumor diameter, nodal volume, and pleural effusion, are prognostic in patients treated with chemoradiation. Clinical T-stage and location (right/left) were likely not prognostic within stage III NSCLC. Inconclusive are several radiomic features, tumor volume, atelectasis, location (pulmonary lobes, central/peripheral), interstitial lung abnormalities, great vessel invasion, pit-fall sign, and cavitation. Conclusions: Tumor-size and nodal size-related factors are prognostic for OS in stage III NSCLC. Future studies should carefully report study characteristics and contrast factors with guideline recognized factors to improve evidence evaluation and validation.

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Section: Resultsmentioning

confidence: 99%

Prognostic factors for overall survival of stage III non-small cell lung cancer patients on computed tomography: A systematic review and meta-analysis

Laar

Amsterdam

Lindert

et al. 2020

Radiotherapy and Oncology

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“…Of these, 13 (52.0%) had pathological N2 disease without N1. The 5-year OS of patients with pN2 disease in Group A was 54.5% (8). They had a better prognosis than previous reports (1,4,5).…”

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confidence: 52%

“…These invasive examinations are related with complications and increase the hospital time or cost. Our study showed that 22 (23.4%) had pathological N0 or N1 disease (8). Even if these patients had received EBUS-TBNA of the mediastinal lymph nodes before surgery, they would have been re-classified as having N0 or N1 disease and subsequently receive upfront resection.…”

mentioning

confidence: 71%

The current only location-based nodal classification in NSCLC may be inadequate

Maniwa¹

2019

J. Thorac. Dis.

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“…In selected patients with good performance status and resectable disease, surgery has been even evaluated as the initial treatment after careful multidisciplinary team discussion, e.g. in case of single N2-station involvement of upper lobe tumors (7), but the literature is still lacking prospective trials confirming the validity of such approach compared to traditional schemes (8). Surgery of locally advanced disease has been traditionally considered challenging.…”

Section: Review Articlementioning

confidence: 99%

Robotic surgery for locally advanced non-small cell lung cancer

Muriana¹,

Perroni²,

Novellis³

et al. 2021

J Vis Surg

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Stage III non-small cell lung cancer (NSCLC) is a heterogeneous group of diseases including large masses, mediastinal lymph node involvement, and invasion of major mediastinal structures. Robotic surgery is a minimally invasive approach recognized as an equivalent alternative to open surgery in case of early stage NSCLC. An increasing number of studies also assert that robotics is a reasonable option for the treatment of locally advanced disease in the setting of multimodality therapy. Major advantages of the technique are increased radicality compared to video-assisted thoracic surgery (VATS), fast postoperative recovery and better compliance to adjuvant therapies compared to open. In this paper we present some technical aspects of the robotic lobectomy in locally advanced disease, we discuss different robotic approaches and review the literature of robotic treatment of lung cancer patients. To describe the technique, we use two case studies of patients affected by locally advanced NSCLC operated with robotic surgery. A patient with right upper lobe (RUL) pulmonary adenocarcinoma and single N2-station metastasis underwent robotic lobectomy following response to induction chemo-radiotherapy. A radical excision of the tumor was obtained with clear margins and no evidence of residual disease at pathologic examination. In the second case, a diagnosis of N2 lymph node metastasis (station R4) from pulmonary adenocarcinoma was made in a patient with primary occult tumor. After induction treatment, the patient underwent robotic radical mediastinal lymph node dissection with curative intent. Unexpected partial invasion of the wall of superior vena cava (SVC) was safely managed with tangential resection. Despite the problems of costs, availability, and learning curve, the Authors believe that robotic surgery has indisputable advantages to obtain a radical resection in case of locally advanced NSCLC.

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Upfront surgery in patients with clinical skip N2 lung cancer based on results of modern radiological examinations

Cited by 12 publications

References 33 publications

Prognostic factors for overall survival of stage III non-small cell lung cancer patients on computed tomography: A systematic review and meta-analysis

Prognostic factors for overall survival of stage III non-small cell lung cancer patients on computed tomography: A systematic review and meta-analysis

The current only location-based nodal classification in NSCLC may be inadequate

Robotic surgery for locally advanced non-small cell lung cancer

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