Video-assisted thoracic surgery systematic mediastinal nodal dissection and stage migration: impact on clinical pathway

Abstract

SND during VMPR is safe and should be routinely performed even when nodal metastases is considered unlikely. VATS-SND is more accurate than PET in staging the mediastinum for NSCLC. PET sensitivity is significantly reduced in adenocarcinoma and might result in stage migration. Adjuvant multidisciplinary treatment should be based on SND staging.

The feasibility of a Two-incision video-assisted thoracoscopic lobectomy

“…Therefore, since the first case of this procedure, the number of dissected lymph node has not been different from the data of our previous three-port VATS lobectomy or lobectomy through standard thoracotomy (20.2 ± 11.2 in this study, 22.1 ± 11.6 in our previous data including three-port VATS lobectomy or lobectomy through standard thoracotomy [20]). Our number of dissected lymph node is much higher than that of the Borro’s report (9.2 ± 5.4) [15] and it is comparable with the other group’s data of standard VATS lobectomy (10~23) [5,21-23]. …”

A standardized technique of systematic mediastinal lymph node dissection by video-assisted thoracoscopic surgery (VATS) leads to a high rate of nodal upstaging in early-stage non-small cell lung cancer

“…However, the nodal upstaging rate was higher than in any other VATS cohort published so far. Amer et al [31] revealed a nearly equal (16.6 %) nodal upstaging rate, but this study included patients with NSCLC also higher than stage I. FDG-PET/CT reveals the highest accuracy in clinical staging of NSCLC with a reported sensitivity, specificity, and negative predictive value of 80-90, 85-95, and 85-94 %, respectively [22]. However, pathological upstaging of any kind (T-, N-or M-factor) is a known and rather frequent fact in NSCLC, demonstrating the limitations of current clinical staging tools and algorithms.…”

Video-Assisted Thoracic Surgery (VATS) Systematic Mediastinal Nodal Dissection

“…• Port-site seedling, which is rare (0.5%) and seems to happen irrespective of whether the nodes were retrieved in a polythene bag or not [32,33]. Minor complications:…”

“…We harvest nodes en-block, stations 2-4,7,8,9,10 and 11 on the right, preserving the Azygos vein, and 4,5-6,7,8,9,10, 11 on the left side, preserving the ligamentum arteriosum [32]. We SND criteria:…”