Optimal mediastinal staging in non-small cell lung cancer: What is the role of TEMLA and VAMLA?

Kużdżał, Jarosław; Warmus, Janusz; Grochowski, Zbigniew

doi:10.1016/j.lungcan.2014.07.015

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…Other authors advocate for extended lymph node resection using a transcervical approach (transcervical extended mediastinal lymphadenectomy, TEMLA) as a staging method and a mediastinal approach. However, it is not clear whether TEMLA improves patient selection and survival compared to complete lymphadenectomy (LND) [ 33 , 34 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Total Thoracoscopic and Robotic Surgery for Lung Cancer Lymphadenectomy

Ureña

Moreno

Macía

et al. 2023

Cancers

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Background: Robotic-assisted thoracic surgery (RATS) is used increasingly frequently in major lung resection for early stage non-small-cell lung cancer (NSCLC) but has not yet been fully evaluated. The aim of this study was to compare the surgical outcomes of lymph node dissection (LND) performed via RATS with those from totally thoracoscopic (TT) four-port videothoracoscopy. Methods: Clinical and pathological data were collected retrospectively from patients with clinical stage N0 NSCLC who underwent pulmonary resection in the form of lobectomy or segmental resection between June 2010 and November 2022. The assessment criteria were number of mediastinal lymph nodes and number of mediastinal stations dissected via the RATS approach compared with the four-port TT approach. Results: A total of 246 pulmonary resections with LND for clinical stages I–II NSCLC were performed: 85 via TT and 161 via RATS. The clinical characteristics of the patients were similar in both groups. The number of mediastinal nodes dissected and mediastinal stations dissected was significantly higher in the RATS group (TT: mean ± SD, 10.72 ± 3.7; RATS, 14.74 ± 6.3 [p < 0.001]), except in the inferior mediastinal stations. There was no difference in terms of postoperative complications. Conclusions: In patients with early stage NSCLC undergoing major lung resection, the quality of hilomediastinal LND performed using RATS was superior to that performed using TT.

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Section: Discussionmentioning

confidence: 99%

A Comparison of Total Thoracoscopic and Robotic Surgery for Lung Cancer Lymphadenectomy

Ureña

Moreno

Macía

et al. 2023

Cancers

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“…Nevertheless, numbers of nodes are impressive, with an average of 38 nodes, occult N2 disease found on 21.8% of the cases and N3 disease on 4.3%, with sensitivity of 95.6%, specificity of 100% and a negative predictive value of 98.4% (12). Unfortunately, there is no published data comparing survival of these N2 patients found only on TEMLA against the patients with post-operative N2 disease treated on adjuvant basis, and another concern is that 21% of patients with no N2 disease deteriorated clinical status and were unfit for lung resection surgery (11).…”

Section: Resultsmentioning

confidence: 99%

“…Then, with the assistance of the Linden-Dahan mediastinoscope, you resect chains 7, 8, 10 right and 4 left (10). Important steps of this procedure are dissection of both recurrent nerves, carotid arteries, brachiocephalic veins, and with the exception of station 9 nodes is the most extensive technique of transcervical dissection (11).…”

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confidence: 99%

Supermediastinoscopies: where to fit and how to do on cancer practice

Melo¹,

Fortunato²,

Pereira³

2018

J. Vis. Surg

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For years cervical mediastinoscopy was the main and only way to access the mediastinal status on lung cancer, but on the last decade new technologies had evolved either imaging, endoscopic or surgical procedures. Each one can give you very good results, but still have a different degree of certainty detecting anatomical extent of disease. Based on some published data and on our experience, we will address the use of video-assisted mediastinal lymphadenectomy (VAMLA) and trans-cervical extended maximal lymphadenectomy (TEMLA), named by Dr. Rami Porta as supermediastinoscopies, show procedures differences and where do we fit them on our practice.

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“…Transcervical extended mediastinal lymphadenectomy (TEMLA) aimed at station 5 and 6 theoretically could have reduced the false negative rate of VAMLA, as 5 out of 8 patients had single station tumor spread in these para-aortic and subaortic nodes that are not sampled through VAM(LA). However, given the concern on morbidity and mortality associated with TEMLA (1) leading to >20% of patients becoming medically inoperable (26), video-assisted thoracoscopic surgery (VATS) may provide a safer approach to sample station 5 and 6 before committing to anatomical resection (27). Moreover, station 5 and 6 could in theory also be sampled via EUS in expert hands (28).…”

Section: Discussionmentioning

confidence: 99%

Surgical mediastinal lymph node staging for non-small-cell lung carcinoma

Lozekoot¹,

Daemen²,

Broek³

et al. 2021

Transl Lung Cancer Res

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Background: The current preferred approach for surgical mediastinal staging of non-small-cell lung carcinoma is video-assisted mediastinoscopy. An alternative technique in which lymph nodes are resected instead of biopsied is video-assisted mediastinoscopic lymphadenectomy (VAMLA) that is suggested to be superior in detecting N2 disease. Yet, evidence is conflicting and furthermore limited by sample size. The objective was to compare mediastinal staging through VAMLA and video-assisted mediastinoscopy.Methods: A single-center cohort study was conducted. All consecutive patients that underwent surgical mediastinal staging of non-small-cell lung carcinoma by VAMLA (2011 to 2018) were compared to historic video-assisted mediastinoscopy controls (2007 to 2011). Patients with negative surgical mediastinal staging underwent subsequent anatomical resection with systematic regional lymphadenectomy. Primary outcome was the sensitivity and negative predictive value for detecting N2 disease.Results: Two-hundred-sixty-nine video-assisted mediastinoscopic lymphadenectomies and 118 videoassisted mediastinoscopies were performed. The prevalence of N2 disease was 20% and 26% respectively in the VAMLA and video-assisted mediastinoscopy group, while the rate of unforeseen pN2 resulting from lymph node dissection during anatomical resection was 4% and 11%, respectively. Invasive staging using VAMLA demonstrated superior sensitivity of 0.82 and a negative predictive value of 0.96 when compared to video-assisted mediastinoscopy (0.62 and 0.89, respectively), offering a 64% decrease in risk of unforeseen pN2 following anatomical resection. However, VAMLA is also associated with a 75% risk increase on complications (P=0.36). Conclusions:We conclude that performing invasive mediastinal lymph node assessment for staging of non-small-cell lung carcinoma, VAMLA should be the preferred technique with superior sensitivity and negative predictive value in detecting N2 disease. Though, VAMLA is also associated with an increased risk of complications.

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Optimal mediastinal staging in non-small cell lung cancer: What is the role of TEMLA and VAMLA?

Cited by 10 publications

References 23 publications

A Comparison of Total Thoracoscopic and Robotic Surgery for Lung Cancer Lymphadenectomy

A Comparison of Total Thoracoscopic and Robotic Surgery for Lung Cancer Lymphadenectomy

Supermediastinoscopies: where to fit and how to do on cancer practice

Surgical mediastinal lymph node staging for non-small-cell lung carcinoma

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