Toker Alper, Özyurtkan Mehmet Oğuzhan, Kaba Erkan
Department of Thoracic Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey.
Department of Thoracic Surgery, Medicana International Istanbul Hospital, Istanbul, Turkey.
J Vis Surg. 2017 May 30;3:76. doi: 10.21037/jovs.2017.04.05. eCollection 2017.
Nodal upstaging after surgical intervention for non-small cell lung cancer (NSCLC) is defined as the presence of unsuspected pathologic hilar (pN1) or mediastinal (pN2) disease detected during the final histopathologic evaluation of surgical specimens. The prevalence of pathologic nodal upstaging is used as a quality measure for the definition of the completeness of the nodal dissection. Risk factors for nodal upstaging may be patient-related (history of tuberculosis, rheumatoid arthritis, and diabetes mellitus), or tumor-related (central tumor, higher T stage, higher SUVmax value, or adenocarcinoma). Actually, the theorical superiority of a minimally invasive resections is the lymph node dissection. Studies may suggest that, expert video-assisted thoracoscopic surgery (VATS) surgeon could do similar lymph node dissection as it is done in open. Robotic surgeons may replicate the results of lymph node dissection in the open techniques. The possible reason for this is the instrumental superiority provided by the higher technology.
非小细胞肺癌（NSCLC）手术干预后淋巴结分期上调定义为在手术标本的最终组织病理学评估中发现意外的病理肺门（pN1）或纵隔（pN2）疾病。病理淋巴结分期上调的发生率用作淋巴结清扫完整性定义的质量指标。淋巴结分期上调的危险因素可能与患者相关（结核病、类风湿性关节炎和糖尿病病史），或与肿瘤相关（中央型肿瘤、更高的T分期、更高的SUVmax值或腺癌）。实际上，微创切除术的理论优势在于淋巴结清扫。研究可能表明，专业的电视辅助胸腔镜手术（VATS）外科医生能够进行与开放手术类似的淋巴结清扫。机器人手术医生可以在开放技术中复制淋巴结清扫的结果。其可能的原因是更高技术所提供的器械优势。
