The impact of left lower paratracheal (4L) lymph node dissection on survival in patients with surgically treated left-sided NSCLC

Gryszko, Grzegorz M; Cackowski, Marcin M; Zbytniewski, Marcin; Woźnica, Katarzyna; Orłowski, T; Dziedzic, Dariusz

doi:10.1093/ejcts/ezab294

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…Intraoperative videos were used to confirm whether LNs were evaluated at the undissected station; however, no significant difference was observed in DFS, thus suggesting that no method was superior for dissection to evaluate metastatic LNs. Recent reports suggesting that station 4L LN dissection has a significant impact prognosis are consistent with our study (15)(16)(17)(18)(19). However, the mediastinal LN dissection sites were selected in these studies; therefore, there may have been selection bias.…”

Section: Discussionsupporting

confidence: 89%

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Mediastinal lymph node evaluation, especially at station 4L, in left upper lobe lung cancer

Hanaoka¹,

Yoden²,

Okamoto³

et al. 2022

J Thorac Dis

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Background: Mediastinal lymph node (LN) dissection during lung resection is essential for accurate staging. Station 4L dissection is anatomically difficult. Therefore, care should be taken to avoid complications. We investigated the importance of mediastinal LN dissection in left upper lobe lung cancer and evaluated intraoperative videos to identify relevant steps during dissection.Methods: We retrospectively reviewed 151 consecutive patients with left upper lobe lung cancer. Finally, 139 patients were enrolled to examine the survival effects of clinical factors of metastatic LN stations. The association between risk factors or surgical procedures and recurrent laryngeal nerve palsy was analyzed.Results: LN dissection of the left upper lobe revealed station 4L LN metastasis in nine patients, three of whom were node-negative on mediastinoscopy. Station 4L LN status was confirmed intraoperatively in 12 of 33 patients. Twenty patients had recurrent laryngeal nerve palsy, four of whom were complicated with aspiration pneumonia. Station 4L LN dissection was an independent risk factor for recurrent laryngeal nerve palsy (P=0.03). The use of an energy device near the recurrent laryngeal nerve was a significant risk factor for recurrent laryngeal nerve palsy. Incidentally, pathological N stage ≥2 was an independent prognostic factor for disease-free survival (DFS) (P=0.005) herein. Conclusions:In patients with left upper lobe lung cancer, pathological N2 disease is an important predictor of recurrence. Therefore, accurate mediastinal LN dissection, including at station 4L, should be performed. We propose to standardize the dissection procedure at each institution to avoid complications, such as recurrent laryngeal nerve palsy.

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Section: Discussionsupporting

confidence: 89%

“…Therefore, some thoracic surgeons do not dissect station 4L. However, recent studies showed that station 4L LN metastasis was an independent risk factor for poor prognosis and that station 4L LN dissection led to a more favorable outcome (15)(16)(17)(18)(19).…”

Section: Original Articlementioning

confidence: 99%

Mediastinal lymph node evaluation, especially at station 4L, in left upper lobe lung cancer

Hanaoka¹,

Yoden²,

Okamoto³

et al. 2022

J Thorac Dis

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“…According to historic reports, the metastasis rate of L4 lymph nodes ranges from 10–20% ( 12 - 16 ). Unlike previous studies that included a variety of patients across clinical stages who underwent thoracotomy, all patients underwent VATS in this study, and among whom the majority were in the early stage.…”

Section: Discussionmentioning

confidence: 99%

“…Similar results were also obtained in the study by Zhao et al ( 13 ). However, Gryszko et al ( 16 ) retrospectively analyzed 659 pairs of patients matched from 5,369 patients by propensity score matching. No difference in 5-year OS was observed (L4 D+ group: 48% vs. L4 D- group: 50%, P=0.65), and multivariable analysis failed to confirm the effect of L4 nodal metastases as an independent prognostic factor.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic value of L4 lymph node dissection during video-assisted thoracoscopic surgery in patients with left-sided non-small cell lung cancer: a single-center, retrospective cohort study

Wu¹,

Fang²,

Li³

et al. 2023

Transl Lung Cancer Res

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Background: Lymph node dissection (LND) is crucial procedure during radical resection of non-small cell lung cancer (NSCLC), but the prognostic value of L4 LND remains elusive. To investigate the prognostic value of L4 LND in patients with left-side NSCLC who underwent video-assisted thoracoscopic surgery (VATS).Methods: Three hundred twelve patients who underwent VATS between Jan. 2007 and Dec. 2016 were reviewed. Of those, 119 underwent L4 LND (L4 D+ ), whereas the other 193 patients did not (L4 D-). The inclusion criteria were as follows: patients diagnosed with primary left-sided NSCLC who underwent VATS lobectomy combined with LND; patients subjected to R0 resection and tumor pathological stage T 1-4 N 0-2 M0. The primary endpoint was overall survival (OS). OS was calculated from the operation date to the date of death. The chi-square test was used for categorical variables, and a t test was used for continuous variables.Results: A total of 119 patients underwent L4 LND, and the procedure was more likely to be performed on upper lobe tumors (P=0.019). Patient distributions with respect to age, gender, smoking history, clinical stage, adjuvant therapy, tumor differentiation and tumor size were well balanced between two groups.More lymph nodes (LNs) were dissected in the L4 D+ group than in the L4 Dgroup (P<0.001). The rate of metastasis to L4 lymph nodes was 9.2%, which was comparable between patients with upper and lower lobe tumors (8.9% vs. 10.0%, P=1.000). The L4 D+ group exhibited a significantly better OS than the L4 Dgroup (median OS: undefined vs. 130 months, HR 0.47; 95% CI: 0.31-0.72; P=0.002). Multivariate analysis showed that L4 LND was an independent factor for OS. However, OS did not significantly differ between the two groups of cT1aN0 and cT1bN0 patients (OS: HR 0.44; 95% CI: 0.18-1.06; P=0.12).Conclusions: L4 LND is recommended for patients with left-sided NSCLC as an essential component of radical resection. The role of L4 LND in cT1a-bN0 disease warrants further study.

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The prognostic value of 4L lymph node dissection in left-side operable non-small-cell lung cancer: a meta-analysis

Peng,

Huang,

Shang

et al. 2023

Updates Surg

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The impact of left lower paratracheal (4L) lymph node dissection on survival in patients with surgically treated left-sided NSCLC

Cited by 8 publications

References 14 publications

Mediastinal lymph node evaluation, especially at station 4L, in left upper lobe lung cancer

Mediastinal lymph node evaluation, especially at station 4L, in left upper lobe lung cancer

Prognostic value of L4 lymph node dissection during video-assisted thoracoscopic surgery in patients with left-sided non-small cell lung cancer: a single-center, retrospective cohort study

The prognostic value of 4L lymph node dissection in left-side operable non-small-cell lung cancer: a meta-analysis

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