Kużdżał Jarosław, Warmus Janusz, Grochowski Zbigniew
Department of Thoracic Surgery, Jagiellonian University, John Paul II Hospital, Cracow, Poland.
Department of Thoracic Surgery, Jagiellonian University, John Paul II Hospital, Cracow, Poland.
Lung Cancer. 2014 Oct;86(1):1-4. doi: 10.1016/j.lungcan.2014.07.015. Epub 2014 Jul 24.
The aim of this review is to present the current role of two techniques of extensive mediastinal dissection, in the staging of lung cancer.
The authors performed a search for original papers published in English language, peer-reviewed journals.
According to the published evidence, definitions of VAMLA and TEMLA are given and the main elements of the operative technique are briefly presented. Extensiveness and completeness of mediastinal lymph node dissection using these techniques, their diagnostic yield as well as complications and use of hospital resources are discussed. The role of VAMLA and TEMLA in the contemporary staging of lung cancer is presented in context of other staging techniques and the current clinical practice guidelines.
On the basis of the evidence currently available, it may be concluded that VAMLA and TEMLA have no contemporarily use in the routine mediastinal staging of lung cancer. This is because of their invasiveness and - at least for TEMLA - high risk of complications and mortality, which renders it unacceptable as a diagnostic procedure, and also due to the development of equally accurate, but far less invasive techniques, i.e. EBUS-NA and EUS-NA.
本综述的目的是介绍两种广泛纵隔清扫技术在肺癌分期中的当前作用。
作者检索了发表在英文同行评审期刊上的原始论文。
根据已发表的证据，给出了VAMLA和TEMLA的定义，并简要介绍了手术技术的主要要素。讨论了使用这些技术进行纵隔淋巴结清扫的广泛性和完整性、其诊断率以及并发症和医院资源的使用情况。在其他分期技术和当前临床实践指南的背景下，介绍了VAMLA和TEMLA在当代肺癌分期中的作用。
根据目前可得的证据，可以得出结论，VAMLA和TEMLA在肺癌常规纵隔分期中目前没有应用。这是因为它们具有侵入性，并且至少对于TEMLA来说，并发症和死亡率风险很高，这使其作为一种诊断程序不可接受，还因为出现了同样准确但侵入性小得多的技术，即EBUS-NA和EUS-NA。
