Die Rolle der Chirurgie beim Lungenkarzinom

Seifert, Sven; Nemat, André T.

doi:10.1007/s10405-009-0358-5

Cited by 2 publications

(1 citation statement)

References 15 publications

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“…Uninterrupted healing of the bronchial stump was witnessed in all but one patient (99.2%). This institutional series called VAMLA as a innocuous and practical procedure in patients with normal or slightly enlarged mediastinal lymph nodes and its capacity as a minimally invasive nevertheless complete technique of systematic nodal dissection prevailing under conditions of clinical routine, producing accuracy data superior to conventional mediastinoscopy, endoscopic FNA procedures, and PET-CT scan ( 48 - 50 )—even if those are applied in combination and, characteristically, in oncologic cohorts presenting high prevalence of extensive mediastinal disease ( 27 , 29 , 31 , 51 , 52 ).…”

Section: Vamla-resultsmentioning

confidence: 99%

Video-assisted mediastinoscopic lymphadenectomy (VAMLA) for staging & treatment of non-small cell lung cancer (NSCLC)

Hartert¹,

Tripsky²,

Huertgen³

2020

Mediastinum

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Precise preoperative staging and restaging of mediastinal lymph nodes in patients with potentially resectable non-small cell lung cancer (NSCLC) is of supreme importance. Over the last years, algorithms on preoperative mediastinal staging incorporating imaging, endoscopic and surgical techniques have been widely published, offering more evidence concerning different mediastinal staging techniques. Current guidelines well define when and how to receive tissue confirmation in case of computed tomography (CT)-enlarged or positron emission tomography (PET)-positive mediastinal lymph nodes. Endosonography [(endoscopic bronchial ultrasonography/oesophageal ultrasonography (EBUS/EUS)] with fine needle aspiration still is the first choice (when accessible) since it is minimally invasive and has a high sensitivity to confirm mediastinal nodal disease. If negative, surgical staging with nodal dissection or biopsy is indicated. Video-assisted mediastinoscopic lymphadenectomy (VAMLA) and transcervical extended mediastinal lymphadenectomy (TEMLA) are preferred over conventional mediastinoscopy if a mediastinal R0-resection can be achieved. The mutual use of endoscopic and surgical staging effects highest accuracy. Straight surgical resection of tumors ≤3 cm (located within the external third of the lung) with systematic nodal dissection is justified as soon as there are no enlarged lymph nodes on CT-scan and once there is no nodal uptake on PET-CT. In case of central tumors and enlarged or FDG avid nodes regardless of cytological result, preoperative invasive mediastinal staging is indicated to rule out mediastinal nodal spread. However, accuracy needed in preoperative nodal staging has been under continuous debate ever since and with the advent of immunotherapy is right now intensely revived. During the last two decades VAMLA has been growing up from being a merely staging tool to an expert-recognized therapeutic tool in the context of minimal invasive lung cancer resection.

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