Kuzdzał Jarosław, Zieliński Marcin, Papla Bolesław, Szlubowski Artur, Hauer Łukasz, Nabiałek Tomasz, Sośnicki Witold, Pankowski Juliusz
Department of Thoracic Surgery, Pulmonary Hospital Zakopane, ul. Gładkie 1, 34-500 Zakopane, Poland.
Eur J Cardiothorac Surg. 2005 Mar;27(3):384-90; discussion 390. doi: 10.1016/j.ejcts.2004.12.008. Epub 2005 Jan 13.
Mediastinal staging is one of the most important problems in thoracic surgery. Although the pathological examination is a generally accepted standard, none of the currently used techniques enables complete removal of all lymph node stations of the mediastinum. The aim of the study is to present a new technique of transcervical extended mediastinal lymphadenctomy (TEMLA) and to analyze its value in lung cancer staging.
In the prospective study of consecutive group of non-small cell lung cancer (NSCLC) patients, operated on between January and August 2004, we evaluated the usefulness of this original technique of bilateral mediastinal lymphadenectomy, assessing its accuracy and safety. The operations were performed through the transcervical approach, were videomediastinoscopy-assisted, with sternum elevation. Lymph node stations 1, 2R, 2L, 3a, 4R, 4L, 5, 6, 7 and 8 were removed. In patients without mediastinal metastases thoracotomy with pulmonary resection was performed and mediastinum searched for any missed lymph nodes.
There were 83 patients operated on with the TEMLA technique. The mean number of nodes removed was 43 (range: 26-85). The sensitivity, specificity and accuracy of the presented method in detecting mediastinal node metastases were: 90, 100, and 96%, respectively, whereas the positive and negative predictive values were: 100 and 95%, respectively.
The TEMLA technique is a safe and highly accurate method of mediastinal staging in NSCLC.
纵隔分期是胸外科最重要的问题之一。虽然病理检查是普遍接受的标准，但目前使用的技术均无法完全切除纵隔的所有淋巴结站。本研究的目的是介绍一种经颈扩大纵隔淋巴结清扫术（TEMLA）的新技术，并分析其在肺癌分期中的价值。
在对2004年1月至8月间连续手术的非小细胞肺癌（NSCLC）患者进行的前瞻性研究中，我们评估了这种双侧纵隔淋巴结清扫术的新技术的实用性，评估其准确性和安全性。手术通过经颈入路进行，采用电视纵隔镜辅助，抬高胸骨。切除第1、2R、2L、3a、4R、4L、5、6、7和8组淋巴结。对于无纵隔转移的患者，进行开胸肺切除术，并在纵隔中寻找任何遗漏的淋巴结。
共有83例患者采用TEMLA技术进行手术。切除淋巴结的平均数量为43个（范围：26 - 85个）。该方法检测纵隔淋巴结转移的敏感性、特异性和准确性分别为90%、100%和96%，而阳性和阴性预测值分别为100%和95%。
TEMLA技术是NSCLC纵隔分期的一种安全且高度准确的方法。
