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Cardiothoracic Surgery |

Lobe-Specific Mediastinal Nodal Dissection Is Sufficient During Lobectomy by VATS or Thoracotomy for Early Stage Lung Cancer

Mark Shapiro*, MD; Sakar Kadakia, BA; Andrew Breglio, BA; Andrew Kaufman, MD; Dong-Seok Lee, MD; Raja Flores, MD
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The Mount Sinai Medical Center, New York, NY


Chest. 2012;142(4_MeetingAbstracts):50A. doi:10.1378/chest.1390785
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Abstract

SESSION TYPE: Thoracic Surgery II

PRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PM

PURPOSE: Lobectomy with complete mediastinal lymphadenectomy is considered standard for patients with early stage non-small cell lung cancer (NSCLC), but frequently results in unnecessary dissection associated with increased morbidity. Since lobe specific nodal drainage patterns are predictable, we hypothesized that lobe-specific lymph node dissection in such patients is sufficient. Therefore, the purpose of this study was to analyze the frequency and pattern of mediastinal nodal disease and its impact on tumor recurrence.

METHODS: All patients with clinical N0/N1 NSCLC determined by means of computed tomographic (CT) and positron emission tomographic (PET) analyses were identified. Disease involvement of surgically dissected nodal stations was recorded. Patterns of recurrence of those who underwent lobectomy with complete mediastinal lymph node (LN) dissection were compared to those who underwent lobe-specific mediastinal lymph node dissection.

RESULTS: From July 2004 to April 2011 there were 390 patients identified. Complete mediastinal LN dissection was performed in 294 patients (28 underwent lobectomy by thoracotomy and 263 had attempted thoracoscopic resection, 74 of which were converted to thoracotomy). Fifteen patients (5.1%) were found to have N2 disease after pathological evaluation. The only tumor characteristic that associated with increased risk of N2 disease in these patients was laterality of the tumor. Patients with left sided tumors were more likely to have pathological N2 disease than patients with right sided tumors (8.4%[10/119] versus 2.9%[5/175]; p=0.03). Only 1 patient with an upper lobe tumor had mediastinal metastasis to level 7 without involvement of level 4 mediastinal nodes (0.3%). Also, patients with complete LN dissection had similar rate of recurrence compared to the group that had lobe-specific mediastinal LN dissection (23.9% vs. 21.3%).

CONCLUSIONS: Mediastinal N2 metastases follow predictable patterns in patients with negative preoperative CT and PET scans. Exceptions are rare. Finally, there is no significant increase in the recurrence rate in patients with lobe specific versus complete mediastinal nodal dissection.

CLINICAL IMPLICATIONS: Lobe-specific mediastinal nodal evaluation is acceptable in patients with early stage NSCLC.

DISCLOSURE: The following authors have nothing to disclose: Mark Shapiro, Sakar Kadakia, Andrew Breglio, Andrew Kaufman, Dong-Seok Lee, Raja Flores

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The Mount Sinai Medical Center, New York, NY

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