Juričić Joško, Ilić Nenad, Frleta Ilić Nives, Ilić Darko, Mrklić Ivana, Pogorelić Zenon
Department of Surgery, Split University Hospital Centre, Spinčićeva 1, 21 000 Split, Croatia.
Policlinic Cito, Moliških Hrvata 4, 21 000 Split, Croatia.
Surgeon. 2014 Aug;12(4):191-4. doi: 10.1016/j.surge.2013.11.019. Epub 2013 Dec 22.
Extent of lymph node involvement in patients with non-small cell lung cancer (NSCLC) is the cornerstone of staging and influences both multimodality treatment and final outcome. The aim of this study was to investigate accuracy and characteristics of intraoperative ultrasound guided systematic mediastinal nodal dissection in patients with resected NSCLC.
From January 2008 to June 2013, 244 patients undergoing intraoperative surgical staging after radical surgery for NSCLC were included in prospective study. The patients were divided in two groups according to systematic mediastinal nodal dissection: 124 patients in intraoperative ultrasound nodal dissection guided group and 120 in standard nodal dissection group. The lymph nodes were mapped by their number and station and histopathologic evaluation was performed.
Operating time was prolonged for 10 min in patients with ultrasound guided mediastinal nodal dissection, but number and stations of evaluated lymph nodes were significantly higher (p < 0.001) in the same group. Skip nodal metastases were found in 24% of patients without N1 nodal involvement. Twelve (10%) patients were upstaged using US guided mediastinal lymphadenectomy. In US guided group 5-year survival rate was 59% and in the group of standard systematic mediastinal lymphadenectomy 43% (p = 0.001) Standard staging system seemed to be improved in ultrasound guided mediastinal lymphadenectomy patients. Complication rate showed no difference between analyzed groups.
Higher number and location of analyzed mediastinal nodal stations in patients with resected NSCLC using ultrasound is suggested to be of great oncological significance. Our results indicate that intraoperative ultrasound may have important staging implications.
非小细胞肺癌（NSCLC）患者的淋巴结受累范围是分期的基石，影响多模式治疗和最终结果。本研究的目的是探讨术中超声引导下系统性纵隔淋巴结清扫术在接受手术切除的NSCLC患者中的准确性和特征。
2008年1月至2013年6月，244例接受NSCLC根治性手术后进行术中手术分期的患者纳入前瞻性研究。根据系统性纵隔淋巴结清扫术将患者分为两组：术中超声引导淋巴结清扫组124例，标准淋巴结清扫组120例。根据淋巴结的数量和部位对淋巴结进行标记，并进行组织病理学评估。
超声引导纵隔淋巴结清扫术患者的手术时间延长了10分钟，但同一组中评估的淋巴结数量和部位明显更多（p<0.001）。在无N1淋巴结受累的患者中，24%发现有跳跃性淋巴结转移。12例（10%）患者通过超声引导纵隔淋巴结清扫术进行了分期上调。超声引导组的5年生存率为59%，标准系统性纵隔淋巴结清扫组为43%（p=0.001）。超声引导纵隔淋巴结清扫术患者的标准分期系统似乎得到了改善。分析组之间的并发症发生率无差异。
对于接受手术切除的NSCLC患者，使用超声检查时纵隔淋巴结站的分析数量和位置更高，这具有重要的肿瘤学意义。我们的结果表明，术中超声可能具有重要的分期意义。
