对于潜在的Ⅰ期进展期非小细胞肺癌，经电视辅助胸腔镜手术切断动脉韧带后行左纵隔淋巴结清扫术。
Left mediastinal node dissection after arterial ligament transection via video-assisted thoracoscopic surgery for potentially advanced stage I non-small cell lung cancer.
作者信息
Shibano Tomoki, Tsubochi Hiroyoshi, Tetsuka Kenji, Yamamoto Shinichi, Kanai Yoshihiko, Minegishi Kentaro, Endo Shunsuke
机构信息
Department of General Thoracic Surgery, Jichi Medical University, Shimotsuke-shi, Tochigi, Japan.
出版信息
J Thorac Dis. 2018 Dec;10(12):6458-6465. doi: 10.21037/jtd.2018.11.86.
BACKGROUND
Left mediastinal node dissection during lung cancer surgery can be difficult because paratracheal and subcarinal lymph nodes are concealed by mediastinal structures. Arterial ligament transection (ALT) offers a wide surgical view of concealed mediastinal spaces, thus enabling extended lymph node dissection (LND). We analyzed surgical outcomes of patients who underwent extended LND after ALT via video-assisted thoracoscopic surgery (VATS) for potentially node-positive clinical stage I non-small cell lung cancer (NSCLC).
METHODS
We retrospectively investigated the medical records of 75 patients who had undergone extended mediastinal node dissection after ALT via VATS for potentially node-positive NSCLC at our centers during the period from September 2008 through November 2015. Operative data and rates of overall survival (OS), in addition to mortality and morbidity, were analyzed in relation pathological stage and nodal stage.
RESULTS
Operative time was 238±58 minutes, and an average of 32.7±12.9 hilar and mediastinal lymph nodes were dissected. Lymph node metastases were detected in 34 patients (6 pN1 patients, 27 pN2 patients, and 1 pN3 patient). Mediastinal lymph node metastases were detected around the carina (stations 2L, 4L, and 7) in 19 of 27 patients with pN2 cancer. Nineteen patients had a total of 24 postoperative complications. Recurrent nerve paralysis was the most frequent complication (n=11) but resolved in eight patients during follow-up. Survival rates at 3 and 5 years were 92.2%/88.4%, 100.0%/60.0%, and 87.7%/81.0% for p-stage I, II, and III, respectively, and 92.2%/88.4%, 100.0%/60.0%, and 87.4%/80.7% for pN0, pN1, and pN2, respectively.
CONCLUSIONS
Extended mediastinal node dissection after ALT allowed detection of lymph node micrometastases in selected patients with potentially node-positive left NSCLC and may improve outcomes.
背景
肺癌手术中左纵隔淋巴结清扫可能具有挑战性，因为气管旁和隆突下淋巴结被纵隔结构遮挡。切断动脉韧带（ALT）可提供广阔视野，便于观察隐蔽的纵隔间隙，从而能够进行扩大淋巴结清扫（LND）。我们分析了通过电视辅助胸腔镜手术（VATS）行ALT后扩大LND的潜在淋巴结阳性临床I期非小细胞肺癌（NSCLC）患者的手术结果。
方法
我们回顾性研究了2008年9月至2015年11月期间在我们中心接受VATS行ALT后扩大纵隔淋巴结清扫的75例潜在淋巴结阳性NSCLC患者的病历。分析了手术数据、总生存率（OS）以及死亡率和发病率，并与病理分期和淋巴结分期相关联。
结果
手术时间为238±58分钟，平均清扫肺门和纵隔淋巴结32.7±12.9枚。34例患者检测到淋巴结转移（6例pN1患者，27例pN2患者，1例pN3患者）。27例pN2期癌症患者中有19例在隆突周围（2L、4L和7区）检测到纵隔淋巴结转移。19例患者共有24例术后并发症。喉返神经麻痹是最常见的并发症（n = 11），但8例患者在随访期间恢复。pI期、II期和III期患者的3年和5年生存率分别为92.2%/88.4%、100.0%/60.0%和87.7%/81.0%，pN0、pN1和pN2患者分别为92.2%/88.4%、100.0%/60.0%和87.4%/80.7%。
结论
ALT后扩大纵隔淋巴结清扫能够在部分潜在淋巴结阳性的左NSCLC患者中检测到淋巴结微转移，可能改善预后。
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