Watanabe Atsushi, Miyajima Masahiro, Mishina Taijiro, Tsuruta Kodai, Takahashi Yuki, Maki Ryunosuke, Tada Makoto
Department of Thoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan.
Surg Today. 2017 Dec;47(12):1419-1428. doi: 10.1007/s00595-017-1494-x. Epub 2017 Mar 11.
Mediastinal node dissection (MND) is an integral component of the surgical treatment for non-small cell lung cancer (NSCLC). Although video-assisted thoracoscopic surgery (VATS) has been used increasingly for lung cancer treatment, the accuracy of by VATS MND still remains controversial. We reviewed the surgical results of VATS MND for NSCLC.
A systematic review of literature was performed, and articles that fully described the surgical procedure, devices, and results of VATS MND were selected to compare the efficacy of MND by VATS and thoracotomy.
Various techniques and equipments have been shown to perform adequate MND, but there is an argument as to the method of estimation of the accuracy of MND. Most of the recent studies showed that the nodal upstaging and number of dissected nodes are significantly lower by VATS than after thoracotomy. Oppositely, some studies showed VATS noninferiority in these issues. Complications such as chylothorax, pleural effusion, bleeding, and nerve damage were similar in both groups.
Although ND by VATS remains controversial, VATS MND is becoming easier and more feasible owing to the development of more advanced endoscopic cameras and equipments. We should learn further to become more adept at performing adequate ND by VATS.
纵隔淋巴结清扫术（MND）是非小细胞肺癌（NSCLC）外科治疗的一个重要组成部分。尽管电视辅助胸腔镜手术（VATS）已越来越多地用于肺癌治疗，但VATS MND的准确性仍存在争议。我们回顾了VATS MND治疗NSCLC的手术结果。
对文献进行系统回顾，选择充分描述VATS MND手术过程、设备和结果的文章，以比较VATS和开胸手术进行MND的疗效。
已证明各种技术和设备可进行充分的MND，但对于MND准确性的评估方法存在争议。最近的大多数研究表明，VATS组的淋巴结分期上调和清扫淋巴结数量明显低于开胸手术后。相反，一些研究表明VATS在这些问题上并不逊色。两组的乳糜胸、胸腔积液、出血和神经损伤等并发症相似。
尽管VATS进行的淋巴结清扫术仍存在争议，但由于更先进的内镜摄像头和设备的发展，VATS MND正变得更容易且更可行。我们应进一步学习，更熟练地通过VATS进行充分的淋巴结清扫。
