Hamaji Masatsugu, Nishikawa Shigeto, Koyasu Sho, Yutaka Yojiro, Kojima Fumitsugu, Nakanishi Takao, Kono Tomoya, Yamada Yoshito, Hijiya Kyoko, Ohata Keiji, Kikuchi Ryutaro, Miyamoto Ei, Nakagawa Tatsuo, Omasa Mitsugu, Miyahara Ryo, Bando Toru, Date Hiroshi
Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Japan.
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Mediastinum. 2025 Mar 7;9:2. doi: 10.21037/med-24-42. eCollection 2025.
Although lymph node metastasis may be an adverse prognostic factor for survival after resection of thymic epithelial malignancies, recommendations for intraoperative lymph node dissection (LND) lack consistency across various guidelines. This study aimed to investigate feasibility and characteristics of LND.
This is a work-in-progress report of our prospective, multi-institutional observational study to evaluate the feasibility and characteristics of LND in patients with resectable thymic epithelial malignancies that exhibit radiological invasive features such as size >5 cm, standardized uptake value >5, or suspected invasion of surrounding organs.
In total, 25 patients were enrolled in this study. All patients underwent complete resection of the primary lesion with N1-level or N2-level LND. Among these, 22 (88%) patients underwent N1-level LND, and 20 (80%) patients underwent N2-level LND. No significant differences between the open and minimally invasive approaches were observed in the number of dissected stations (P=0.71), N1-level LND (P=0.49), or N2-level LND (P=0.69).
Intraoperative LND may be feasible in both approaches and may contribute to accurate nodal staging in resectable thymic malignancies with radiologically invasive features.
尽管淋巴结转移可能是胸腺上皮性恶性肿瘤切除术后生存的不良预后因素，但不同指南对术中淋巴结清扫（LND）的建议缺乏一致性。本研究旨在探讨LND的可行性和特点。
这是一项前瞻性、多机构观察性研究的进展报告，旨在评估对具有放射学侵袭特征（如大小>5 cm、标准化摄取值>5或怀疑侵犯周围器官）的可切除胸腺上皮性恶性肿瘤患者进行LND的可行性和特点。
本研究共纳入25例患者。所有患者均接受了原发灶的完整切除及N1级或N2级LND。其中，22例（88%）患者接受了N1级LND，20例（80%）患者接受了N2级LND。在清扫站数（P=0.71）、N1级LND（P=0.49）或N2级LND（P=0.69）方面，开放手术和微创手术方法之间未观察到显著差异。
术中LND在两种手术方法中可能都是可行的，并且可能有助于对具有放射学侵袭特征的可切除胸腺恶性肿瘤进行准确的淋巴结分期。
