Yoshimasu Tatsuya, Miyoshi Shinichiro, Oura Shoji, Hirai Issei, Kokawa Yozo, Okamura Yoshitaka
Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Japan.
J Thorac Cardiovasc Surg. 2005 Aug;130(2):433-7. doi: 10.1016/j.jtcvs.2005.02.005.
Although radioisotopic procedures are commonly used to detect sentinel lymph nodes in breast cancer surgery, these procedures are often problematic and not necessarily suitable for lung cancer surgery.
Our previous study revealed that the mediastinal sentinel lymph node, defined as the regional mediastinal lymph node, consisted of nodes 2, 3, or 4 in right upper lobe cancers; 3, 7, or 8 in right lower lobe cancers; 4, 5, or 7 in left upper lobe cancers; and 4, 7, or 8 in left lower lobe cancers. On the basis of these findings, we pathologically investigated one representative lymph node at each of the 3 levels dissected during surgical intervention in 69 patients with non-small cell lung cancer from September 1993 through December 2002. Fifty-eight patients with lung cancer underwent lobectomies with limited mediastinal lymph node dissection according to this strategy.
Mediastinal lymph node recurrence was observed in only one patient during 41 +/- 25 months (maximum, 98 months) of follow-up. The cancer-specific 5-year survivals were 96.6% in patients with pathologic stage IA disease (n = 31) and 67.4% in patients with stage IB disease (n = 16).
These results suggested that limited mediastinal lymph node dissection is applicable to patients with non-small cell lung cancer whose regional mediastinal lymph nodes are not metastatic.
尽管放射性同位素检查常用于乳腺癌手术中前哨淋巴结的检测，但这些检查往往存在问题，不一定适用于肺癌手术。
我们之前的研究表明，纵隔前哨淋巴结，即区域纵隔淋巴结，在右上叶癌中由第2、3或4组淋巴结组成；在右下叶癌中由第3、7或8组淋巴结组成；在左上叶癌中由第4、5或7组淋巴结组成；在左下叶癌中由第4、7或8组淋巴结组成。基于这些发现，我们对1993年9月至2002年12月期间69例非小细胞肺癌患者手术干预时所解剖的3个层面中的每个层面的一个代表性淋巴结进行了病理研究。58例肺癌患者根据该策略接受了肺叶切除术并进行了有限的纵隔淋巴结清扫。
在41±25个月（最长98个月）的随访期间，仅1例患者出现纵隔淋巴结复发。病理分期为IA期的患者（n = 31）的癌症特异性5年生存率为96.6%，IB期患者（n = 16）为67.4%。
这些结果表明，有限的纵隔淋巴结清扫适用于区域纵隔淋巴结无转移的非小细胞肺癌患者。
