Validity of using lobe-specific regional lymph node stations to assist navigation during lymph node dissection in early stage non-small cell lung cancer patients

• Published in: Surgery today (Tokyo, Japan) Vol. 44; no. 11; pp. 2028 - 2036
• Main Authors: Miyoshi, Shinichiro, Shien, Kazuhiko, Toyooka, Shinichi, Miyoshi, Kentaroh, Yamamoto, Hiromasa, Sugimoto, Seiichiro, Soh, Junichi, Hayama, Makio, Yamane, Masaomi, Oto, Takahiro
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-11-2014
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Female; Humans; Intraoperative Period; Lung Neoplasms - diagnosis; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Node Excision - methods; Lymphatic Metastasis; Male; Mediastinum; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness; Neoplasm Staging; Original Article; Surgery; Surgical Oncology; Young Adult; Lymphadenectomy; Lobe-specific regional lymph node station; Non-small cell lung cancer
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-013-0772-5

Purpose
The validity of our proposed lobe-specific regional lymph node stations (LSRLNS) was evaluated as a method for navigation during lymphadenectomy in patients with early stage non-small cell lung cancer (NSCLC).
Methods
A total of 725 NSCLC patients with c-T2N1M0 or less extensive disease who had undergone a curative operation with complete mediastinal lymph node dissection (MLND) were studied. The LSRLNS were #2, #3, #4 and #10 for the right upper lobe, #11i, #11s, #7 and #8 for the right lower lobe, #4, #5 and #6 for the left superior division, #11, #5 and #7 for the left lingular division and #11, #7 and #8 for the left lower lobe.
Results
If the LSRLNS were used for pathological examinations during surgery, 599 p-N0 and 39 p-N1 patients diagnosed with no metastasis would have been subjected to a selective MLND, while 20 p-N1 and 65 p-N2 patients who had a diagnosis of metastasis would have been navigated to a complete MLND. Two p-N2 patients with a diagnosis of no metastasis would have inappropriately undergone a selective MLND, resulting in the false negative rate at 0.3 %.
Conclusion
Intra-operative pathological examination using our LSRLNS may accurately reveal the status of metastasis, and appropriately lead to a selective or complete MLND in patients with c-T2N1M0 or less extensive disease.