Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Eur J Cardiothorac Surg. 2012 Apr;41(4):834-8. doi: 10.1093/ejcts/ezr059. Epub 2012 Jan 18.
In patients with early-stage non-small cell lung cancer, surgery offers the best chance of cure when a complete resection, including mediastinal lymph node dissection, is performed. A definition for complete resection and guidelines for intra-operative lymph node staging have been published, but it is unclear whether these guidelines are followed in daily practice. The goal of this study was to evaluate the extent of mediastinal lymph node dissection routinely performed during lung cancer surgery, and hereby the completeness of resection according to the guidelines of the European Society of Thoracic Surgery (ESTS) for intra-operative lymph node staging.
In a retrospective cohort study, the extent of mediastinal lymph node dissection was evaluated in 216 patients who underwent surgery for lung cancer with a curative intent in four different hospitals, three community hospitals and one university hospital. Data regarding clinical staging, the type of resection and extent of lymph node dissection were collected from both the patient's medical record and the surgical and pathology report. Based on histology, location and side of the primary tumour, the extent of mediastinal dissection was compared with the ESTS guidelines for intra-operative lymph node staging.
According to the surgical report interlobar and hilar lymph nodes were dissected in one-third of patients. A mediastinal lymph node exploration was performed in 75% of patients; however, subcarinal lymph nodes were dissected in <50% of patients and at least three mediastinal lymph node stations were investigated in 36% of patients. In 35% of the mediastinal stations explored, lymph nodes were sampled instead of a complete dissection of the entire station. A complete lymph node dissection according to the guidelines of the ESTS was performed in 4% of patients. Despite an incomplete dissection unexpected mediastinal lymph nodes were found in 5% of patients.
In daily practice, the intended curative resection for lung cancer cannot be considered complete in the majority of patients, because of an incomplete lymph node dissection according to the current guidelines of the ESTS.
在早期非小细胞肺癌患者中，当进行完全切除（包括纵隔淋巴结清扫）时，手术是治愈的最佳机会。已经发布了完全切除的定义和术中淋巴结分期指南，但尚不清楚这些指南在日常实践中是否得到遵循。本研究的目的是评估在四家不同医院（三家社区医院和一家大学医院）进行肺癌手术时常规进行的纵隔淋巴结清扫的范围，并根据欧洲胸外科协会（ESTS）的术中淋巴结分期指南评估切除的完整性。
在一项回顾性队列研究中，评估了 216 例在四家不同医院（三家社区医院和一家大学医院）因肺癌接受根治性手术的患者的纵隔淋巴结清扫范围。从患者的病历和手术及病理报告中收集了临床分期、手术类型和淋巴结清扫范围的数据。根据组织学、原发肿瘤的位置和侧别，将纵隔清扫范围与 ESTS 术中淋巴结分期指南进行比较。
根据手术报告，三分之一的患者进行了叶间和肺门淋巴结清扫。75%的患者进行了纵隔淋巴结探查；然而，<50%的患者进行了隆突下淋巴结清扫，只有 36%的患者探查了至少三个纵隔淋巴结站。在探查的 35%纵隔站中，只进行了淋巴结取样，而不是整个站的完整解剖。根据 ESTS 指南，4%的患者进行了完全淋巴结清扫。尽管淋巴结清扫不完整，但仍有 5%的患者在术中发现了意外的纵隔淋巴结。
在日常实践中，由于不符合 ESTS 目前指南的不完全淋巴结清扫，大多数患者的肺癌根治性切除不能被认为是完整的。
