Strategies of Lymph Node Dissection During Sublobar Resection for Early-Stage Lung Cancer

Gossot, Dominique; Mariolo, Alessio Vincenzo; Lefèvre, Marine; Boddaert, Guillaume; Brian, Emmanuel; Grigoroiu, Mădălina; Girard, Nicolas; Seguin‐Givelet, Agathe

doi:10.3389/fsurg.2021.725005

Cited by 11 publications

(8 citation statements)

References 40 publications

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“…Robotic surgery has evolved rapidly worldwide in the last 5 years in thoracic surgery. Clear advantages have been reported on a center-specific level, namely, enhanced visualization, the ability to dissect into the mediastinum, segmental resection, and lymph node dissection ( 22 ). From a more objective perspective, three randomized trials have directly compared robotic [robotic-assisted thoracic surgery (RATS)] vs. conventional video-assisted [video-assisted thoracic surgery (VATS)] approaches in lung resection surgery, namely, RAVAL, ROMAN, and RVLob ( 23 – 27 ).…”

Section: Minimally Invasive Surgical Advances and Implications On Lym...mentioning

confidence: 99%

Lymph node dissection in lung cancer surgery

Patel,

Bille

2024

Front. Surg.

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Lung cancer, a leading cause of cancer-related death, often requires surgical resection for early-stage cases, with recent data supporting less invasive resections for tumors smaller than 2 cm. Central to resection is lymph node assessment, an area of controversy worldwide, compounded by advances in minimally invasive techniques. The review aims to assess current standards for lymph node assessment, recent data from the surgical era, and the immunobiological basis of how lymph node metastases impact patient outcomes. The British Thoracic Society guidelines recommend systematic nodal dissection during lung cancer resection, without specifying node removal or sampling. Historical data on mediastinal lymph node dissection (MLND) survival benefits are inconclusive, although proponents argue for lower recurrence rates. Recent trials such as ACOSOG Z0030 found no survival difference between MLND and nodal sampling, reinforcing the need for robust staging. While lobe-specific dissection strategies have been proposed, they currently lack consensus. JCOG1413 aims to compare the clinical benefits of lobe-specific and systematic dissection. TNM-9 staging revisions emphasize the prognostic significance of single-station N2 involvement. Robotic surgery shows promise, with trials such as RAVAL, which reported comparable outcomes to video-assisted thoracic surgery (VATS) and improved lymph node sampling. Immunobiological insights suggest preserving key immunological sites during lymphadenectomy, especially for patients receiving adjuvant immunotherapy. In conclusion, the standard lymph node resection strategy remains unsettled. The debate between systematic and selective dissection continues, with implications for staging accuracy and patient outcomes. As minimally invasive techniques evolve, robotic surgery emerges as an effective and low-risk approach to delivering optimal lymph node assessment.

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Section: Minimally Invasive Surgical Advances and Implications On Lym...mentioning

confidence: 99%

Lymph node dissection in lung cancer surgery

Patel,

Bille

2024

Front. Surg.

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“…A factor that shall not be underestimated is the systemic hilar and mediastinal lymphadenectomy as a prognostic factor for a better outcome and better staging ( 9 ). Gossot et al ( 10 ) emphasize the importance of the intraoperative frozen section of the lymph nodes and suggest a conversion to a lobectomy in case of lymph node involvement.…”

Section: Nodal Status Does Mattermentioning

confidence: 99%

“…Gossot et al ( 10 ) argue that the basic oncological principles of radical resection with adequate margins and a radical lymph node dissection (loco-regional and mediastinal) should be respected when performing a segmentectomy. A further recommendation based on the findings of Matsumura et al ( 11 ) is that the segmental peribronchial lymph nodes and the adjacent lymph nodes (aLNs) should be examined during the operation as they could possibly indicate spread to other isolated lymph nodes (iLNs).…”

Section: Nodal Status Does Mattermentioning

confidence: 99%

Is “less actually enough” when it comes to left upper division tumors?

Gioutsos¹,

Galanis²,

Dorn³

2023

J Thorac Dis

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“…However, due to aberrant lymphatic drainage paths in the thorax, the first lymph node relay may be located at different lymph node station. Indeed, there may be a direct mediastinal involvement such as well-described skip N2 ( 7 ), a hilar or scissural involvement, adjacent lymph node involvement or even an isolated lymph node involvement ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

What is the appropriate “first lymph node” in the era of segmentectomy for non-small cell lung cancer?

Seitlinger

Stasiak²,

Piccoli³

et al. 2023

Front. Oncol.

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IntroductionThe place of segmentectomy in the management of lung cancer is shifting following the inspiring results of the Japanese JCOG0802 trial. I n this study, authors suggested that performing segmentectomy would require in an optimal way an intraoperative confirmation of pN0 tumor with a frozen section. Our objective was to determine whether the proposed technique, i.e. adjacent lymph node analysis, is consistent with the results of our study on sentinel lymph node (SLN) detection using fluorescence.MethodsThis is a retrospective, observational, single center study. Eighty-one patients with suspected localized stage NSCLC (IA to IIA) were included between December 2020 and March 2022. All patients received an intra-operative injection of indocyanine green (ICG) directly in the peritumoral area or by electromagnetic navigational bronchoscopy (ENB). The SLN was then assessed by using an infrared fluorescence camera.ResultsIn our cohort, SLN was identified in 60/81 patients (74.1%). In 15/60 patients with identified SLN (25%), NIR-guided SLN was concordant with the suggestions of JCOG0802 study. A retrospective SLN pathological analysis was performed in 43 patients/60 cases with identified SLN (71.2%), including 37 cases of malignant disease. Occult micro-metastases were found in 4 patients out of 37 SLN analyzed, leading to a 10.8% upstaging with NIR-guided SLN analysis.DicussionAt the time of segmentectomies, ICG technique allowed the identification of the SLN in a high percent of cases and in some areas usually out of the recommended stations for lymph node dissection.

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Strategies of Lymph Node Dissection During Sublobar Resection for Early-Stage Lung Cancer

Cited by 11 publications

References 40 publications

Lymph node dissection in lung cancer surgery

Lymph node dissection in lung cancer surgery

Is “less actually enough” when it comes to left upper division tumors?

What is the appropriate “first lymph node” in the era of segmentectomy for non-small cell lung cancer?

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