Subcarinal Lymph Nodes Should be Dissected in All Lobectomies for Non-Small Cell Lung Cancer—Regardless of Primary Tumor Location

Eckardt, Jens; Jakobsen, Erik; Licht, Peter B.

doi:10.1016/j.athoracsur.2016.09.109

Cited by 8 publications

(9 citation statements)

References 25 publications

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“…We have already suggested this conclusion [2]. However, it is of prime importance to recall in addition the potential underlying significance of subcarinal LN tumoral involvement.…”

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confidence: 67%

“…However, it is of prime importance to recall in addition the potential underlying significance of subcarinal LN tumoral involvement. We observed in a surgical series [2] that pN2 involvement concomitantly existed in the upper and lower mediastinum in 40% to 81% of patients according to the side and location within the lobe of NSCLC; the lower mediastinum mainly consisted in subcarinal N2. Multistation N2 involvement is known to worsen the prognosis.…”

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confidence: 95%

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Eckardt

Jakobsen

Licht

2018

The Annals of Thoracic Surgery

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“…We have already suggested this conclusion [2]. However, it is of prime importance to recall in addition the potential underlying significance of subcarinal LN tumoral involvement.…”

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confidence: 67%

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confidence: 95%

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Eckardt

Jakobsen

Licht

2018

The Annals of Thoracic Surgery

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“…But a recent study showed that the proportion of subcarinal lymph nodes involvement was also high in the right (21.8%) and left (25.8%) upper lobe tumors (22). Similarly, Eckardt et al concluded that lymph nodes #7 should be removed in any location of lobectomy to avoid understaging (23).…”

Section: Discussionmentioning

confidence: 99%

Video-assisted versus open thoracotomy lobectomy: comparison on lymphadenectomy and survival in early stage of lung cancer

Dziedzic¹,

Zbytniewski²,

Gryszko³

et al. 2021

J Thorac Dis

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Background: Video-assisted thoracic surgery (VATS) is increasingly used in the surgical treatment of early lung cancer, but the oncological benefits are still controversial. We aimed to compare videoassisted lobectomy and open thoracotomy lobectomy in terms of lymphadenectomy and long-term survival depending on the location of lobectomy. Methods: A retrospective, multicenter study was based on the Polish Lung Cancer Study Group and included patients with stage I lung cancer who were surgically treated between 2007 and 2015. We included 1410 patients after video-assisted lobectomy and 4,855 after open thoracotomy. Results: The average number of lymph nodes removed in video-assisted lobectomy was 10.9 and in open thoracotomy lobectomy was 12.9 (P<0.001). The 5-year survival was better in the video-assisted lobectomy group (78.6%) compared to open thoracotomy (73.8%) (P=0.002). Significant differences were found in the case of left lower lobe and left upper lobe lobectomies. Multivariable analysis showed that the prognostic factors for open thoracotomy relative to video-assisted lobectomy are: age over 60 [HR (95% CI): 1.55 (1.17-2.05), P=0.002], female [HR (95% CI): 1.57 (1.07-2.29), P=0.02], squamous cell carcinoma [HR (95% CI): 1.63 (1.12-2.37), P=0.011], left lower lobe [HR (95% CI): 2.69 (1.37-5.27), P=0.004] and left upper lobe [HR (95% CI): 1.53 (1.01-2.33), P=0.047]. Conclusions:The study showed that the number of lymph nodes removed during video-assisted lobectomy is significantly lower than in the open thoracotomy group. The long-term video-assisted lobectomy results were significantly better compared to open thoracotomy. Better long-term results were achieved on the left side of lobectomy.

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“…For left lingular division, Haruki et al 11 and Riquet et al 30 both reported that the highest incidence of metastasis was upper zone, for which we did not combine RML with RUL as non-lower lobe to analyze in spite of the resembling anatomic location. Eckardt et al 31 reported that unexpected subcarinal metastases were found in 5.9%, 5.1% and 1.6% of patients with a tumor in the lower, middle and upper lobe, respectively. Rocha et al 12 also concluded that tumor located in a lower lobe was significantly associated with upstaging.…”

Section: Discussionmentioning

confidence: 99%

Correlation between tumor location and survival in stage I lung adenocarcinoma and squamous cell carcinoma: a SEER-based study

Hu¹,

Qi²,

Zhu³

et al. 2021

J. Cancer

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Background: Whether location mattered remained controversial in early-stage non-small cell lung cancer. Methods: We conducted a retrospective study with the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and lung cancer-specific survival (LCSS) with landmark analysis and restricted mean survival time (RMST) were compared between patients with a tumor in upper lobe and non-upper lobe. The multivariable Cox analysis was applied to evaluate multiple prognostic factors. Results: Tumor in non-upper lobe had worse OS (hazard ratio [HR]: 1.354, p < 0.001) and LCSS (HR: 1.476, p = 0.005) than the upper lobe in stage IB adenocarcinoma in 32-month landmark and IA3 (OS, HR: 1.300, p < 0.001; LCSS, HR: 1.413, p = 0.004) adenocarcinoma in 48-month landmark, but not in stage IA1 and IA2 adenocarcinoma. The results remained positive in subgroups of < 4, ≥ 4 and ≥ 11 LN examined in stage IB tumor and ≥ 4 LN examined in stage IA3 tumor. For SCC, non-upper lobar tumor had similar OS and LCSS with upper lobar tumor in all stages. The multivariate Cox analysis confirmed that the non-upper lobe was an independent risk factor in stage IA3-IB adenocarcinoma, but not in SCC. Adjuvant chemotherapy (ACT) could improve OS in stage IB adenocarcinoma (HR: 0.586, p < 0.001) and SCC (HR: 0.708, p = 0.030) located in non-upper lobe. Conclusions: Non-upper lobar adenocarcinoma in stage IA3-IB was associated with worse prognosis. ACT may improve prognosis in stage IB tumor located in non-upper lobe.

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Subcarinal Lymph Nodes Should be Dissected in All Lobectomies for Non-Small Cell Lung Cancer—Regardless of Primary Tumor Location

Cited by 8 publications

References 25 publications

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Video-assisted versus open thoracotomy lobectomy: comparison on lymphadenectomy and survival in early stage of lung cancer

Correlation between tumor location and survival in stage I lung adenocarcinoma and squamous cell carcinoma: a SEER-based study

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