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S. Ikeda
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P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.02-030 - Effectiveness of Extended Bilateral Superior Mediastinal Lymph Node Dissection Through a Median Sternotomy in Patients with Left NSCLC (ID 2335)
09:30 - 09:30 | Author(s): S. Ikeda
- Abstract
Background:
Lymph node dissection plays important role in oncologic surgery. The removal of the whole regional lymphatic system together with primary tumor is one of the fundamental rules in oncological surgery. But, the role of surgical treatment in non-small-cell lung cancer (NSCLC) with clinically manifested mediastinal lymph node metastasis is controversial. Bilateral paratracheal lymphnodes for left side tumors are considered inaccessible through a standard thoracotomy. It is difficult to perform complete dissection of superior mediastinal lymph nodes through the left thoracotomy in the left lung cancer. We had devised Systemic extended bilateral superior mediastinal dissection and lung resection through a median sternotomy (ND3 operation, Hata’s method), and reported that ND3 operation can allow for complete dissection of all stations of mediastinal lymph nodes. The aim of this study was to evaluate the surgical outcomes and long term survival in patients of survival of the patient with non-small lung cancer (NSCLC) who underwent our ND3 operation.
Methods:
We retrospectively studied 289 patients ( 202 male and 87 female, mean ages 59.7 years (range, 38-75)) , underwent ND3 operation due to Left NSCLC, from January 1988 till December 2014. The patients with NSCLC of left side primary who are estimated to be able to conventional radical operation and aged 75 years old or less becomes the adaptation of our ND3 operation. Postoperative survival rates calculated with Kaplan-Meier method. Clinicopathological data were compared according to the p stage.
Results:
Overall 5-year survival rate in the 289 patients of left lung primary was 64.6%. Operative mortality in 289 patients was 3.0%,1.2% from January 200１ till December 2014. Lymph node metastasis to the mediastinum was confirmed in 98 (33.9%) patients (pN2 was 50 patients,pN3α was 29 patients, pN3β was 2 patients, pN3γ was 17 patients). According to pathological stages, five-year survival rate was was 88.7% in stage IA, 75.3% in stage IB, 60.6% in stage IIA, 71.4% in stageIIB, 47.5% in stageIIIA, 39.6% in stageIIIB. Five-year survival rate was 48% in pN2 cases, and 48.8% in pN3α cases. Compere with previouse our reports, this result is more safety and better prognosis.
Conclusion:
Our result suggest that ND3 operation would provide better prognosis in the patients with pN2 and pN3α Lt.NSCLC. And better local tumor control by ND3 operation than conventional lung cancer operation does not increase mortality.Lung cancer surgery should be denied due to clinical N status because patient with N2,N3 disease NSCLC can be operated for curative intent by our ND3 with acceptable surgical risk and long term survival.
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P2.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 210)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Localized Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.02-026 - Mediastainal Lymph Node Metasatsis Pattern from Left Upper Lobe Cancer: Results of Bilateral Superior Mediastinal Nodal Dissection (ID 2228)
09:30 - 09:30 | Author(s): S. Ikeda
- Abstract
Background:
The accurate assessment of lymph node involvement is an important part of the management of lung cancer. However, due to anatomical limitations imposed by arch of aorta, it is difficult to perform complete dissection of superior mediastinal lymph nodes through the left thoracotomy in the left lung cancer. The aim of this study is to evaluate the location, frequency of metastatic lymph nodes in the mediastinum among patients with left upper lung cancer who underwent complete dissection of the bilateral superior mediastinal lymph node through a median sternotomy (Hata’s method, ND3 operation).
Methods:
202 patients with left upper lobe cancer underwent extended radical mediastinal lymph node dissection. We retrospectively studied clinical data of these patients [202 male and 87 female, mean ages 60.2 years (range, 38-75)], underwent ND3 operation due to NSCLC, from January 1988 till December 2014. Mediastinal nodal status was assessed according to the systems of IASLC lymph node map 2009. The superior mediastinal lymph nodes which cannot be dissected through a left thoracotomy (bilateral #1,#2 and #4, right #3a according to IASLC lymph node map 2009 were defined as extra-superior mediastinal nodes for left lung cancer .
Results:
N1 disease was identified in 28 patients,N2 was in 39 patients, N3α disease was in 18, N3γ disease was in 10. 67 patients (33.2%) had one or more metastases to mediastinal lymph nodes . Among them the most common metastatic station was the aortic nodes (AP Zone). 34 cases (50.7%) had metastasis to #5 or #6 (19 cases(29.2%) to #5 and 15 cases (22.4%) to #6). Mediastinal lymph nodes metastasis occurred 34 cases in absence of N1 metastasis. Among the 48 cases with aortic nodes metastasis, 45.8%(22 cases) had Upper Zone (superior mediastinal nodes) metastasis. The next common metastatic station was #4L nodes (24 cases(35.8%)). Metastasis to the Upper Zone lymph nodes occurred in 32 cases of the 202 cases (15.8%), representing 47.8% rate of occurrence (32/67) among those with mediastinal nodal involvement. Furthermore, Upper Zone metastasis was rare 5.0% in the absence of aortic node metastasis.
Conclusion:
The aortic lymph node is the most common site of metastasis from left upper lobe cancer. Based upon the rates of metastasis in our study, dissection of aortic nodes and left tracheobronchial nodes may be important for patients with left upper lobe cancer. We conclude our procedure (Hata’s method, ND3 operation) improve pTNM staging in left upper lobe lung cancer,whether Upper Zone dissection has a beneficial effect on prognosis remains controversial.
