Significance of Metastatic Disease in Subaortic Lymph Nodes

Patterson, G.A.; Piazza, Diego; Pearson, F.G.; Todd, Thomas R.J.; Ginsberg, Robert J.; Goldberg, Melvyn; Waters, Paul F.; Jones, Donald P.; Ilves, Riivo; Cooper, Joel D.

doi:10.1016/s0003-4975(10)60386-4

Cited by 158 publications

(65 citation statements)

References 8 publications

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“…When patients with single N2 positivity were compared, it was identified that patient survey rates with aorticopulmonary lymph involvement were significantly different from the patients with single N2 involvement. Patterson et al [3], reported that 5-year survival after resection was 42% in 35 cases with single subaortic LN metastasis. Martini and Flinger [15] reported the 5-year survival rate for similar patients as 35%.…”

Section: Discussionmentioning

confidence: 99%

“…In N2 disease, the metastatic LN station number and degree of invasion are important in terms of surgical evaluation. Today, resectable NSCLC patients who do not have bulky and multi-station LN metastasis and who have same side N2 positivity not showing capsule invasion undergo the surgical approach at well-recognized centers following neoadjuvant treatment [3,4]. There are some studies evaluating the survival rates of N2 disease on the left upper lobe tumors that have isolated station 5 and/or 6th involvements on which surgical operation have been applied among mediastinal lymph node involvements, and studies evaluating the survival rates of single station N2 disease.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of the Isolated Aorticopulmonary Lymph Node on Survival in Lung Cancer

Özkan¹

2016

Ann Clin Anal Med

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Anahtar KelimelerAortikopulmoner; Metastaz; Lenf Nodu; Akciğer Kanseri Abstract Aim: This study aims to investigate investigate the effects of aorticopulmonary LN metastasis and other N1 and N2 LN involvements on survival rates especially for left upper lobe tumors. Material and Method: 111 cases who underwent surgery due to NSCLC and were diagnosed with lymph node metastasis secondary to the postoperative pathological examination, were examined retrospectively. The cases on whom complete resection and mediastinal lymph node dissection were applied and who were diagnosed with postoperative mediastinal LN metastasis were examined with regard to the effects of some prognostic factors on survival. Results: 13 of the cases who were followed up for 21.41 months on average lost their lives. In the general survival analysis, it was found that isolated aorticopulmonary LN metastasis did not affect survival differently from other N2 diseases. Discussion: This paper claims that in cases with NSCLC located on the left upper lobe, isolated aorticopulmonary LN involvement does not have a negative effect on survival different from other N2 stations but further studies need for support this idea. Therefore, these cases should not be considered as inoperable and complete resection should be performed on the appropriate patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of the Isolated Aorticopulmonary Lymph Node on Survival in Lung Cancer

Özkan¹

2016

Ann Clin Anal Med

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“…However, Watanabe did not determine any significant difference among survivals of multiple N2 patients with and without subcarinal lymph node involvements (4). Patterson et al expressed that in case of preoperative determination of subcarinal node involvement patient should be considered as inoperable (23). In our study, mean survival of the patients in Group 1 was determined to be 50.5 months, mean survival of the patients in Group 2 was determined to be 61.3 months, mean survival of the patients in Group 3 was determined to be 34.4 months, mean survival of the patients in Group 4 was determined to be 42.1 months and mean survival of the patients in Group 5 was determined to be 29.8 months.…”

Section: Discussionmentioning

confidence: 99%

Survival Analysis in N2 (+) Patients for Whom Surgical Resection Was Performed

Hekimoğlu¹,

Gülhan²,

Akkaş³

et al. 2018

Akd Med J

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Objective: This study aimed to demonstrate survival assessment and determine survival of the number of metastatic stations which N2 lymph node station was involvement. Material and Methods:Ninety six (10.6%) patients with N2 lymph node metastasis in 901 patients who had been operated for Non-Small Cell Lung Cancer (NSCLC) at hospital from January 2009 to October 2013, were included in the study. The patients were analized under two main headings. In the first title the survival analysis was performed depending on single station or multiple stations of lymph node involvement. In the second title patients were divided into 5 groups according to metastatic lymph node stations. Group 1 was composed of superior (No 2&4) stations metastases (20.8%), Group 2 was aorticopulmonary window (No 5&6) stations metastases(26%), Group 3 was central (No 7) station (13.5%), Group 4 was inferior (No 8&9) stations metastases(14.6%) and Group 5 was multiple station metastases were determined (25%).Results: Average survival time was 33.3 months and the median survival time was 30.8 months. In patients with mediastinal lymph node metastasis, comparison of survival difference in single-multiple stations; median survival of 55.7 months in single station and median survival of 25.5 months in multiple stations has been found. Single station involvement was determined to caused statistically significant better survival (p <0.05). Group 1&2 in comparison to 3&5 lead to better survival and statistical significance (p <0.05) was observed. Conclusion:Single station N2 involvement should be expected in better survival rates compared to the involvement of multiple stations. Due to decreased survival observed especially with the involvement of level 7 station. It has to be sampled in pre-peri operative period.Key Words: Lung cancer surgery, Metastatic N2 lymph nodes, Survival ÖZ Amaç: Bu çalışma, operasyon sonrası metastatik olduğu saptanan N2 lenf nodu istasyonlarının sağkalım değerlendirmesini ve hangi N2 istasyon tutulumunun sağkalımının daha iyi olduğunun gösterilmesini amaçlamıştır. Gereç ve Yöntemler:Hastanemizde Ocak 2009-Ekim 2013 tarihleri arasında küçük hücreli dışı primer akciğer kanseri nedeni ile opere edilen 901 hastadan N2 lenf nodu metastazı tespit edilmiş 96 (%10,6) hasta çalışmamıza dahil edildi. Hastalar iki ana başlık altında incelendi. İlk başlıkta, lenf nodu istasyonu tutulumunun tek istasyon ve multipl istasyon olmasına göre ve ikinci başlıkta ise metastatik lenf nodu istasyonlarına göre 5 gruba ayrılarak tutulumların sağkalıma etkileri değerlendirildi. Grup Factors influencing survival were statistically analyzed via Kaplan-Meier Method. Also statistical comparisons of survival differences among groups were calculated using Log rank test and Chi-square test. Statistical outcomes were considered to be statistically significant within confidence interval of 95% and significance level of p<0.05. RESULTSThere was a total of 96 patients, of which 75 were male (78.1%) and 21 were female (21.9%), that were included in the...

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“…The added parasternal procedure changed treatment in only one patient (3%). It may even be argued that patients with subaortic or para-aortic lymph node me tastasis without any further mediastinal dissemination will benefit from complete surgical resection [12,18].…”

Section: Discussionmentioning

confidence: 99%

The value of parasternal mediastinoscopy in staging bronchial carcinoma

Barendregt

Deleu²,

Joosten³

et al. 1995

European Journal of Cardio-Thoracic Surgery

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Abstract. Computed tomography (CT) is the non-invasive staging procedure of choice for assessment of metas tasis to mediastinal lymph nodes in patients with bronchial carcinoma. Cervical mediastinoscopy can provide his tologic evidence of mediastinal spread to the peritracheal, tracheobronchial and subcarinal lymph nodes. Subaortic and para-aortic nodes cannot be sampled via this route. The present study was performed to assess the staging value of the parasternal mediastinoscopy as a separate entity. Cervical and parasternal mediastinoscopy was performed in 37 patients with a proven diagnosis of non-small cell carcinoma of the left upper lobe. In 16 pa tients lymph node or tumor tissue could be biopsied via the parasternal route, in 21 patients no parasternal bi opsy was taken. Of the 16 cases with biopsies, only one was positive (6%). Histologic examination of lymph node biopsy tissue was false negative in one other patient (6%). Of the 21 patients without biopsies taken during par asternal mediastinoscopy, three (14%) had proven lymphogenic spread to the subaortic and para-aortic nodes, detected at thoracotomy. The parasternal procedure changed treatment in only one patient (3%). Diagnostic sen sitivity was 20%. It is concluded that parasternal mediastinoscopy should not be used as a routine staging proce dure in patients with left upper lobe lung cancer. [Eur J Cardio-thorac Surg (1995) 9: 655-658] Key words: Parasternal -Mediastinoscopy -Lung cancerThe value of mediastinoscopy in the preoperative assessment of bronchial carcinoma is a subject of ongoing dis cussion. Cervical mediastinoscopy should be used for stag ing in the case of a so-called positive computed tomogra phy (CT) scan (mediastinal lymph nodes of 1.5 cm diam eter or larger, or a group of nodes each 1.0 cm or larger) [4J. Histologic evidence of mediastinal metastasis is man datory in all cases of enlarged nodes on CT scan.The value of parasternal (anterior) mediastinoscopy or mediastinotomy has been discussed in only a few recent publications [1, 4, 5,8,11,14]. In many instances no dif ference is made between the staging value of the cervical and the parasternal procedure. Due to the route of lympho genic spread, the parasternal mediastinoscopy is supposed to be important in the preoperative assessment of left upper lobe tumors [3,10,15]. The benefit of cervical mediasti noscopy is limited to patients with central mediastinal in volvement. Parasternal mediastinotomy is an alternative procedure, but is apparently more invasive than mediasti noscopy. The extended cervical mediastinoscopy, as ad vocated by Ginsberg, is not practised by many surgeons [1]. In some institutes the attitude towards mediastinos copy in general, and towards parasternal mediastinoscopy in particular, appears to have changed. This is partly due to the development of improved CT imaging techniques, which show mediastinal structures with a higher defini tion than 5 or 10 years ago, In order to reassess the value of the staging of lympho genic spread of bronchial carcinoma b...

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Significance of Metastatic Disease in Subaortic Lymph Nodes

Cited by 158 publications

References 8 publications

The Effect of the Isolated Aorticopulmonary Lymph Node on Survival in Lung Cancer

The Effect of the Isolated Aorticopulmonary Lymph Node on Survival in Lung Cancer

Survival Analysis in N2 (+) Patients for Whom Surgical Resection Was Performed

The value of parasternal mediastinoscopy in staging bronchial carcinoma

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