Author of

• 11595

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  P2.07 - Poster Session 2 - Surgery (ID 190)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11625

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    P2.07-030 - The Role of Mediastinal Lymph Node Dissection during Pulmonary Metastasectomy in Patients with No Evidence of Mediastinal Lymph Node Metastasis Based on Preoperative Computed Tomography and Positron Emission Tomography (ID 2616)

    09:30 - 09:30  |  Author(s): J.Y. Kim
    • Abstract

    Background
    The clinical impact of mediastinal lymph node dissection (MLND) during pulmonary metastasectomy remains controversial. Especially the prognostic contribution of MLND on the prevention of tumor recurrence in patients with no evidence of mediastinal lymph node metastasis has not been clearly defined. We aimed to clarify the role of MLND during pulmonary metastasectomy in this population.

    Methods
    We retrospectively reviewed 632 patients who underwent pulmonary metastasectomy from January 2006 to December 2010 in Asan Medical Center. Among them, two hundred nine patients were identified to meet the following criteria and comprised the current study population: the presence of preoperative computed tomography (CT) and positron emission tomography (PET) within 2 months before pulmonary metastasectomy, definite control of the primary tumor, and no evidence of mediastinal lymph node metastasis. Of 209 patients, sixty-seven patients underwent MLND during pulmonary metastasectomy (MLND group), whereas 142 patients underwent pulmonary resection only (non-MLND group). Between-group recurrence-free survival was compared, and risk factors for tumor recurrence were evaluated. The data on tumor recurrence were obtained through a median follow-up duration of 42 months (range 2-83 months).

    Results
    The study population was composed of 119 male and 90 female, and the age at the first pulmonary metastasectomy ranged from 13 to 82 years (median, 56 years). Primary tumor pathologies included colorectal cancer (n=104, 49.8%), hepatobiliary cancer (n=38, 18.2%), kidney cancer (n=17, 8.1%), sarcoma (n=14, 6.7%), and the others (n=36, 17.2%). Disease-free interval from initial primary tumor treatment to the first metastasis ranged from 1 to 94 months (median, 25 months). Overall 5 year recurrence-free survival rate was 30.1%. There was no difference in recurrence rates between the MLND group and the non-MLND group (5 year recurrence-free survival: 30.0% vs. 24.5%, p=0.927). On multivariable analysis, primary tumor histopathology (p<0.001), disease-free interval (p=0.016), and the number of nodules (p<0.001) emerged as significant and independent prognostic factors for recurrence. After adjustment by these three significant variables, mediastinal lymph node dissection did not affect recurrence-free survival (hazard ratio, 0.924; 95% confidence interval, 0.641-1.333; p=0.672).

    Conclusion
    Tumor recurrence after pulmonary metastasectomy was affected by the histopathology of the primary tumor, disease-free interval, and the number of metastatic nodules. However, the role of mediastinal lymph node dissection as a part of pulmonary metastasectomy is obscure in patients with no evidence of mediastinal lymph node metastasis based on CT and PET.