Thoracoscopic lobectomy with systemic lymph node dissection for lymph node positive non-small cell lung cancer--is thoracoscopic lymph node dissection feasible?

Thorac Cardiovasc Surg. 2008 Apr;56(3):162-6. doi: 10.1055/s-2007-989368.

Abstract

Introduction: The impact of thoracoscopic systemic lymph node dissection (LND) on loco-regional control of non-small cell lung cancer (NSCLC) with positive lymph node metastasis was investigated.

Patients and methods: Thoracoscopic lobectomy with systemic LND was performed for clinical stage I NSCLC. 340 patients were admitted for either a thoracoscopic (n = 98) or a standard open (n = 242) lobectomy with systemic LND. Of those 340 cases, 75 cases (20 thoracoscopic and 55 open) were pathologically diagnosed with node-positive disease. A retrospective chart review of these 75 cases was performed.

Results: No significant difference in the overall or loco-regional recurrence-free survival was observed between the groups. The results of a multivariate analysis of the overall and the loco-regional recurrence-free survival demonstrated that the significant factors were tumor size for overall recurrence-free survival, and sex and surgical procedure (use of thoracoscopic surgery) for loco-regional recurrence-free survival, respectively.

Conclusion: In general, thoracoscopic lobectomy for c-stage I disease may have no survival disadvantage over open procedures. It might, however, increase the risk of local recurrence when used to treat pathologically node-positive disease. Caution should be used when treating those cases with thoracoscopic surgery.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Carcinoma, Non-Small-Cell Lung / secondary*
  • Carcinoma, Non-Small-Cell Lung / surgery
  • Disease-Free Survival
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Japan / epidemiology
  • Lung Neoplasms / pathology
  • Lung Neoplasms / surgery*
  • Lymph Node Excision / methods*
  • Lymph Nodes / pathology
  • Lymph Nodes / surgery
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology
  • Neoplasm Staging
  • Pneumonectomy / methods*
  • Retrospective Studies
  • Risk Factors
  • Thoracoscopy / methods*
  • Thoracotomy / methods*
  • Treatment Outcome