Department of Thoracic Surgery, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey.
J Thorac Cardiovasc Surg. 2013 Oct;146(4):774-80. doi: 10.1016/j.jtcvs.2013.04.036. Epub 2013 Jun 15.
We aimed to analyze the accuracy of video-assisted mediastinoscopic lymphadenectomy (VAMLA) as a tool for preoperative staging and the impact of the technique on survival in patients with non-small cell lung cancer (NSCLC) undergoing pulmonary resection.
Between May 2006 and December 2010, 433 patients underwent pulmonary resection for NSCLC, 89 (21%) had VAMLA before resection and 344 (79%) had standard mediastinoscopy. The patients who had negative VAMLA/mediastinoscopy results underwent anatomic pulmonary resection and systematic lymph node dissection.
The median and mean numbers of resected lymph node stations were 5 and 4.9 in the VAMLA group and 4 and 4.2 in the mediastinoscopy group (P = .9). The mean number of lymph nodes per biopsy specimen using standard mediastinoscopy was 10.1, whereas it was 30.4 using VAMLA (P < .001). VAMLA unveiled N2 or N3 disease in 30 (33.7%) and in 6 (6.7%) of patients, respectively. The negative predictive value, sensitivity, false-negative value, and accuracy of VAMLA were statistically higher in the VAMLA groups compared with those of standard mediastinoscopy. The 5-year survival was 90% for VAMLA patients and 66% for mediastinoscopy patients (P = .01). By multivariable analysis, VAMLA was associated with better survival (odds ratio, 1.34; 95% confidence interval, 1.1-3.2; P = .02).
VAMLA was associated with improved survival in NSCLC patients who had resectional surgery.
我们旨在分析视频辅助纵隔镜淋巴结切除术（VAMLA）作为术前分期工具的准确性，以及该技术对接受肺切除术的非小细胞肺癌（NSCLC）患者生存的影响。
2006 年 5 月至 2010 年 12 月，433 例 NSCLC 患者接受了肺切除术，其中 89 例（21%）在切除前进行了 VAMLA，344 例（79%）进行了标准纵隔镜检查。VAMLA/纵隔镜检查结果阴性的患者接受了解剖性肺切除术和系统淋巴结清扫术。
VAMLA 组的中位数和平均淋巴结切除站数分别为 5 和 4.9，纵隔镜组分别为 4 和 4.2（P=0.9）。使用标准纵隔镜检查时，每个活检标本的平均淋巴结数为 10.1，而使用 VAMLA 时为 30.4（P<0.001）。VAMLA 分别在 30 例（33.7%）和 6 例（6.7%）患者中发现 N2 或 N3 疾病。VAMLA 的阴性预测值、灵敏度、假阴性值和准确性在 VAMLA 组均明显高于标准纵隔镜组。VAMLA 组患者的 5 年生存率为 90%，纵隔镜组为 66%（P=0.01）。多变量分析显示，VAMLA 与更好的生存相关（比值比，1.34；95%置信区间，1.1-3.2；P=0.02）。
VAMLA 与接受切除术的 NSCLC 患者的生存改善相关。
