Author of

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  O20 - Staging and Advanced Disease (ID 102)

  • Event: WCLC 2013
  • Type: Oral Abstract Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:P.A. Ugalde, S. Yendamuri
  • Coordinates: 10/29/2013, 16:15 - 17:45, Parkside 110 A+B, Level 1

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    O20.03 - Lobe-specific lymphadenectomy protocol for non-small cell lung cancer presenting as a solitary pulmonary nodule (ID 1763)

    16:35 - 16:45  |  Author(s): Z. Zhao
    • Abstract
    • Presentation
    • Slides

    Background
    We sought to establish an acceptable lobe-specific mediastinal lymphadenectomy protocol for non-small cell lung cancer (NSCLC) presenting as solitary pulmonary nodules (SPN) .

    Methods
    We retrospectively analyzed 415 patients pathologically diagnosed as NSCLC undergone lobectomy, bilobectomy or pneumonectomy with systematic lymphadenectomy from March 2004 to June 2011 in our hospital. All of the patients enrolled were considered SPN preoperatively. Information about primary tumor location, lymph node metastasis, and other baseline data were collected. Stepwise logistic regressions using N1 and lobe-specific regional mediastinal lymph nodes’ conditions as covariates were used to figure out the key lymph node station that indicated non-regional mediastinal lymph nodes metastases (NRM).

    Results
    As for the location of the primary tumor, 121 cases were in right upper lung (RUL), 42 in right middle lung (RML), 77 in right lower lung (RLL), 107 in left upper lung (LUL), and 68 in left lower lung (LLL). Stepwise regression showed that #2(OR (odds ratio) = 28.250, 95%CI (confidence interval): 1.756-454.422, P=0.018), N1 (OR=24.000, 95%CI: 3.346-172.121, P=0.002) and N1 (OR=21.667, 95%CI: 3.266-143.736, P=0.001) was the key lymph node station for RUL, LUL and RLL, respectively. None of the covariates show statistical significant for LLL.Patients with tumors >2 cm rarely had NRM without primary regional mediastinal involvement. Figure 1 Figure. Malignant cells’ residue when the key station shows negative metastasis

    Conclusion
    With rigid consideration, lobe-specific lymphadenectomy is feasible in practice. This protocol could be established when the lobe-specific key nodes show negative under intraoperative frozen section, especially for those NSCLCs presented as SPN smaller than 2 cm preoperatively. Table. Protocols for lobe-specific mediastinal lymphadenectomy for SPN

    	Tumor locations
    	RUL	LUL	RLL	LLL	RML
    Superior mediastinum^4	◎	◎	○[b]	◎	◎
    Inferior mediastinum	○[a]	○[b]	◎	◎	◎
    Note: ◎: Complete regional lymphadenectomy is warranted; ○: Lymph nodes dissection could be omitted considerably. [a]: when #2 shows negative in intraoperative frozen section; [b]: when #10, 11 shows negative in intraoperative frozen section; ^4: #1-4 in RUL, #4-7 in LUL

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