Fourdrain Alex, Epailly Julien, Blanchard Chloé, Georges Olivier, Meynier Jonathan, Berna Pascal
Department of Thoracic Surgery, Amiens University Hospital, Amiens, France; Research Unit SSPC (Simplification des Soins des Patients chirurgicaux Complexes), Amiens University Hospital, Amiens, France.
Department of Thoracic Surgery, Amiens University Hospital, Amiens, France.
Lung Cancer. 2021 Apr;154:118-123. doi: 10.1016/j.lungcan.2021.02.023. Epub 2021 Feb 22.
Lung cancer tumors are known to be highly lymphophilic. There are two different pattern of lymphatic drainage of the lung: one peribronchial lymphatic pathway, and another one within the visceral pleura which appears to be more intersegmental than the peribronchial pathway. We aimed to assess the prevalence of an intersegmental pathway in the lymphatic drainage of lung tumors within the visceral pleura and determine potential influential factors.
In this prospective study, we included all patients for whom a major pulmonary resection (lobar) was indicated and performed for suspected or proven lung cancer. An immediate ex-vivo evaluation of the surgical specimen after resection was conducted by trans-pleural injection of blue dye within the tumor. The pathways followed by the lymphatic vessels under the visceral pleura were assessed to define the occurrence of an intersegmental pathway, which was defined by the presence of blue dye within the lymphatic vessel crossing to a neighboring pulmonary segment, distinct from the tumorous segment.
Fifty-three patients met the inclusion criteria and were assessed over a three-year period. Lymphatic drainage within the visceral pleura followed an intersegmental pathway in 35 of 53 patients (66 %). When the lymphatic drainage of the tumor was intersegmental, it drained in a single other segment in 21/35 cases and two or more in 14/35 cases. Logistic regression with multivariate analysis showed a peripheral location of the tumor to be a risk factor for the intersegmental pathway of visceral pleura lymphatic drainage (OR = 0.87 [079-0.95], p = 0.003).
These results confirm that lymphatic drainage of lung cancer in the visceral pleura appears to largely follow an intersegmental pathway, especially when the tumor is peripheral, close to the visceral pleura.
已知肺癌肿瘤具有高度亲淋巴性。肺的淋巴引流有两种不同模式：一种是支气管周围淋巴途径，另一种是脏层胸膜内的途径，后者似乎比支气管周围途径更具节段间性。我们旨在评估脏层胸膜内肺肿瘤淋巴引流中节段间途径的发生率，并确定潜在影响因素。
在这项前瞻性研究中，我们纳入了所有因疑似或确诊肺癌而接受主要肺切除术（肺叶切除）的患者。切除后通过经胸膜向肿瘤内注射蓝色染料对手术标本进行即时离体评估。评估脏层胸膜下淋巴管的走行途径以确定节段间途径的发生情况，节段间途径定义为淋巴管内蓝色染料穿过至相邻肺段（与肿瘤所在段不同）。
53例患者符合纳入标准，在三年期间接受了评估。53例患者中有35例（66%）脏层胸膜内的淋巴引流遵循节段间途径。当肿瘤的淋巴引流为节段间性时，21/35例引流至单个其他段，14/35例引流至两个或更多段。多变量分析的逻辑回归显示肿瘤位于外周是脏层胸膜淋巴引流节段间途径的危险因素（OR = 0.87 [0.79 - 0.95]，p = 0.003）。
这些结果证实，脏层胸膜内肺癌的淋巴引流似乎很大程度上遵循节段间途径，尤其是当肿瘤位于外周、靠近脏层胸膜时。
