Adequacy of intra-operative nodal staging during lung cancer surgery: a poorly achieved minimum objective

Riquet, Marc; Pricopi, C.; Mangiameli, Giuseppe; Arame, Alex; Badia, A.; Barthes, F. Le Pimpec

doi:10.21037/jtd.2018.01.174

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…Our data support the eighth TNM classification where only two N categories (N1 and N2) remain. This N category reclassification is due to the fact that intrapleural and extrapleural nodes are now grouped into category N1 because it seems that for MPM, survival is more affected by the number of nodes involved than by the specific anatomical locations of nodal disease as in lung cancer [ 40 , 41 , 42 , 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience

Mangiameli

Bottoni

Voulaz

et al. 2021

JCM

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Background: We analysed a series of malignant pleural mesothelioma (MPM) patients who consecutively underwent extended Pleurectomy/Decortication (eP/D) in a centre with a high level of thoracic surgery experience (IRCCS Humanitas Research Hospital) to explore postoperative morbidity and mortality, pattern of recurrence and survival. Methods: A retrospective analysis was performed on MPM patients underwent eP/D in our centre from 2010 to 2021. All patients were identified from our departmental database. Postoperative complications were scored according to Clavien–Dindo criteria. Survival analysis was performed by the Kaplan–Meier methods and Cox multivariable analysis. Results: Eighty-five patients underwent extended pleurectomy decortication (eP/D) during study period. Macroscopical residual disease (R2) was reported in one case. A neoadjuvant chemotherapy regiment was administrated in 88% of the surgical cohort. A complete trimodality treatment including induction with platinum agents and pemetrexed, radical cytoreductive surgery and volumetric modulated arc therapy technology (VMAT) could be administered in 63 patients (74%). Postoperative morbidity rate was 54.11%, major complications (defined as Clavien–Dindo ≥ 3) were reported in 11 patients (12.9%). Thirty-day mortality and 90-day mortality were, respectively, 2.35% and 3.53%. Median disease-free and overall survival were, respectively, 13.7 and 25.5 months. The occurrence of major complications (Clavien–Dindo ≥ 3), operative time, pT3–T4, pathological node involvement (pN+) were prognostic factors associated with worse survival. Conclusions: In our experience, eP/D is a well-tolerated procedure with acceptable mortality and morbidity, allowing for the administration of trimodality regimens in most patients. eP/D offered in a multimodality treatment setting have satisfactory long term oncological results. To obtain best oncological results the goal of surgery should be macroscopic complete resection in carefully selected patients (clinical N0).

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Section: Discussionmentioning

confidence: 99%

Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience

Mangiameli

Bottoni

Voulaz

et al. 2021

JCM

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“…In the same manner, even if in current surgical guidelines the role and the extension of the lymphadenectomy are currently available, an accurate lymphadenectomy is not always performed. Several studies showed that patients randomized to complete MLND have less additional postoperative morbidity as compared with those undergoing random LN sampling (LNS), and generally, MLND does not increase the length of stay (17)(18)(19)(20)(21). Furthermore, about 15% of pN+ patients had mediastinal LN metastasis that did not follow a lobe-specific lymphatic diffusion, justifying a radical dissection of mediastinal nodes to avoid misdiagnosis of metastatic nodes, not lobe-specific lymphatic stations (22).…”

Section: Principles Of Resection Surgerymentioning

confidence: 99%

Lung Cancer Treatment: From Tradition to Innovation

Mangiameli

Cioffi²,

Testori³

2022

Front. Oncol.

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Lung cancer (LC) is the second most commonly diagnosed cancer and the primary cause of cancer death worldwide in 2020. LC treatment is associated with huge costs for patients and society; consequently, there is an increasing interest in the prevention, early detection with screening, and development of new treatments. Its surgical management accounts for at least 90% of the activity of thoracic surgery departments. Surgery is the treatment of choice for early-stage non-small cell LC. In this article, we discuss the state of the art of thoracic surgery for surgical management of LC. We start by describing the milestones of LC treatment, which are lobectomy and an adequate lymphadenectomy, and then we focus on the traditional and innovative minimally invasive surgical approaches available: video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS). A brief overview of the innovation and future perspective in thoracic surgery will close this mini-review.

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“…All surgical studies advocate the need for correctly dissecting the LNs; the role and the extension of the lymphadenectomy is currently included in surgical guidelines (14). An accurate mediastinal staging is mandatory for prognostic reasons as well as to determine the need for adjuvant therapies given the possibility of recurrence of occult pathologic nodal disease (pN+) (15).…”

Section: Lymphadenectomymentioning

confidence: 99%

The State of the Art in Thoracic Surgery: Treating Lung Cancer Between Tradition and Innovation

Mangiameli,

Cioffi,

Alloisio

et al. 2022

Metastasis

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Lung cancer is the second most diagnosed cancer and was the primary cause of cancer death worldwide in 2020. Lung cancer treatment is associated with huge costs for patients and society.Consequently, there is an increasing interest on prevention, early detection with screening, and development of new treatments. Surgical management accounts for at least 90% of the activity of thoracic surgery departments. Surgery is the treatment of choice for stages I and II non-small cell lung cancer. In this chapter, we discuss the state of art of thoracic surgery for surgical management of lung cancer. We start describing the milestones of lung cancer treatment, Note to the Reader: This chapter is part of the book Metastasis (ISBN: 978-0-6453320-2-5), scheduled for publication in April 2022. The book is being published by Exon Publications,

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Adequacy of intra-operative nodal staging during lung cancer surgery: a poorly achieved minimum objective

Cited by 3 publications

References 24 publications

Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience

Extended Pleurectomy/Decortication for Malignant Pleural Mesothelioma: Humanitas’s Experience

Lung Cancer Treatment: From Tradition to Innovation

The State of the Art in Thoracic Surgery: Treating Lung Cancer Between Tradition and Innovation

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