Which Mediastinal Lymph Nodes should be Examined During Operation for Diagnosing N0 or N1 Disease in Bronchogenic Carcinoma?

Miyoshi, Shinichiro; Maebeya, Shinji; Suzuma, Takaomi; Bessho, Toshiya; Hirai, Ikuko; Tanino, Hirokazu; Yoshimasu, Tatsuya; Arimoto, Junji; Naito, Yasuaki; Nishino, Eisei

doi:10.2482/haigan.37.475

Cited by 8 publications

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“…Because the aim of surgery is to perform "R0 resection" with the best lymph node assessment, complete LND is recommended [29,[64][65][66][67] because it is the guarantor of accurate lymph node staging and is not associated with more complications compared to other lymph node assessment [68][69][70][71]. The lobe specific lymph node assessment, defined in surgical guidelines [66,67], could be performed for specific cases as cT1 tumors [66], or tumors of less than 30 mm without metastasis in the first lobar node, N1 area, on frozen section [67], and seems to lead to a lower up-staging rate, without any adverse outcomes concerning long-term survival [72][73][74][75].…”

Section: Enhanced Recovery After Surgery and Prehabilitationmentioning

confidence: 99%

The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives—State of the Art

Montagne

Guisier

Vénissac

et al. 2021

Cancers

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Non-small cell lung cancers (NSCLC) are different today, due to the increased use of screening programs and of innovative systemic therapies, leading to the diagnosis of earlier and pre-invasive tumors, and of more advanced and controlled metastatic tumors. Surgery for NSCLC remains the cornerstone treatment when it can be performed. The role of surgery and surgeons has also evolved because surgeons not only perform the initial curative lung cancer resection but they also accompany and follow-up patients from pre-operative rehabilitation, to treatment for recurrences. Surgery is personalized, according to cancer characteristics, including cancer extensions, from pre-invasive and local tumors to locally advanced, metastatic disease, or residual disease after medical treatment, anticipating recurrences, and patients’ characteristics. Surgical management is constantly evolving to offer the best oncologic resection adapted to each NSCLC stage. Today, NSCLC can be considered as a chronic disease and surgery is a valuable tool for the diagnosis and treatment of recurrences, and in palliative conditions to relieve dyspnea and improve patients’ comfort.

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Section: Enhanced Recovery After Surgery and Prehabilitationmentioning

confidence: 99%

The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives—State of the Art

Montagne

Guisier

Vénissac

et al. 2021

Cancers

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“…As a preliminary study, 4 we retrospectively reviewed the patterns of mediastinal lymph node metastasis in relation to the location of primary lung cancer in 55 patients with pathologic N2 disease who underwent resection of a primary lesion and standard mediastinal lymphadenectomy. Lymph node mapping was conducted according to the criteria of the Japanese Lung Cancer Society.…”

Section: Methodsmentioning

confidence: 99%

“…We 4 previously investigated which mediastinal lymph node levels should be examined during surgical intervention to diagnose N2 or less than N2 disease in patients with bronchogenic carcinomas. With primary tumors, 3 mediastinal lymph node levels were selected for each lobe and defined as regional mediastinal lymph nodes; the idea of the regional mediastinal lymph node is quite similar to that of the sentinel lymph node.…”

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confidence: 99%

Limited mediastinal lymph node dissection for non-small cell lung cancer according to intraoperative histologic examinations

Yoshimasu

Miyoshi

Oura

et al. 2005

The Journal of Thoracic and Cardiovascular Surgery

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“…Thus, Miyoshi et al (15) in a sentinel LN study found that mediastinal sentinel LN were 2R, 3 or 4R in RUL; 3, 7 or 8 in RLL; 4L, 5 or 7 in LUL and 4L, 7 or 8 in LLL cancers. Asamura et al (16) reporting 166 pN2 patients noticed that LN-station 7 resection was not always necessary in case of upper lobes NSCLC.…”

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From anatomy to lung cancer: questioning lobe-specific mediastinal lymphadenectomy reliability

et al. 2016

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The prognosis of non-small cell lung cancer (NSCLC) is improving (1-3). The standard treatment of early-stage, mainly lobectomy with systematic complete hilar and mediastinal lymphadenectomy (MLND) (4), is questioned nowadays. Minimal surgery or still less aggressive procedures are being advocated and gaining preference due to emergence and development of new technologies. In fact, diagnosis of NSCLC in early-stage is more frequent and clinical-staging more precise, with the risk of overlooking lymph node (LN) involvement and distant metastasis becoming regularly smaller. Thus, surgeons are attempting to define the minimal and suitable extents of lung resection and LN-dissection, a technique concerning the latter being recently revisited in the review (5).LN-involvement is effectively the keystone of long-term prognosis, and the quality of LN-dissection has always been a matter of debate. Complete-MLND permits the most curative resection by minimizing the risk of leaving tumor-LN behind and provides the most accurate pathological-TNM, which is crucial in adapting the best adjuvant therapy. Thus, complete-MLND is the gold standard. The reason of its relevance is demonstrated by anatomy and pathology studies.An anatomical study was conducted in adult cadavers to research whether lymphatic vessels (LV) directly draining into the mediastinal LN without crossing a n y i n t r a p u l m o n a r y L N c o u l d e x p l a i n s k i p p i n g metastases (6). Direct LVs into the mediastinal LN were observed in 54 right and 60 left lungs. Those direct LVs existed more often from the right and left upper lobes (RUL n=24 and LUL n=41) and mainly went into the upper mediastinum. However, there were three direct LVs from the RULs (12.5%) into the trachea-bronchial LN [LNstation 7 (7,8)] and one from the LULs (2.4%). Direct LVs were less frequent from the right and left lower lobes (RLL n=22 and LLL n=19) and mainly went into LN-station 7. However, nine from the RLL (41%) went into the right paratracheal LN 3, 4R (7,8) Another anatomical study including all the lymphatic drainages into the mediastinum and not only the direct ones (9), demonstrated that the RULs (n=99) had 20 LVs (20%) draining into the LN-station 7 and that the RLLs (n=178) had 87 LVs (48.9%) draining into the LN-station 2R, 3, and 4R. The LULs (n=178) had 25 LVs (14%) draining into the LN-station 7 and two (1.1%) into the LNs of the pulmonary ligament 8)]. The LLLs (n=166) had 99 LVs (59.6%) draining into the LNstation 4L and eight (4.8%) into the LN-station 5. Because of the high frequency of the lymphatic drainage from one lobe towards non-"lobe-specific" LN-stations in the mediastinum, anatomy logically supports recommending complete-MLND for NSCLC.In the same paper (9), the lymphatic drainage was compared with the tumoral involvement of the mediastinal LNs obtained by complete-MLND in 260 pN2-patients. 46 times and the LN station 2R, 3, and 4R involved in 15 (32.6%). The tumor was located in the LUL 68 times and the LN-station 7 involved in eight patients ...

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Which Mediastinal Lymph Nodes should be Examined During Operation for Diagnosing N0 or N1 Disease in Bronchogenic Carcinoma?

Cited by 8 publications

References 0 publications

The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives—State of the Art

The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives—State of the Art

Limited mediastinal lymph node dissection for non-small cell lung cancer according to intraoperative histologic examinations

From anatomy to lung cancer: questioning lobe-specific mediastinal lymphadenectomy reliability

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