Author of

• 16831

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  P1.06 - Poster Session with Presenters Present (ID 458)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Advanced NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 16861

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    P1.06-030 - Extended Lymph Node Dissection through Median Sternotomy in N3 Left NSCLC Surgical Results and Anatomical Findings (ID 5553)

    14:30 - 14:30  |  Author(s): T. Hoshino
    • Abstract

    Background:
    The role of surgical approach to stage IIIA or IIIB disease surgery has been considered not appropriate. Patients with mediastinal lymph node metastasis have a poor prognosis, especially for N3 (contra lateral lymph node metastases) diseases, and lung operation is not typically indicated. We performed bilateral mediastinal lymph node dissection by median sternotomy to resect lung cancer and dissect the bilateral mediastinal lymph nodes.
    
    Methods:
    An extended surgical approach to bilateral neck and mediastinal nodal dissection based on the knowledge about the pathways of lymph drainage,’ systematic neck and bilateral mediastinal nodal dissection through a median sternotomy,’ beyond the anatomical difficulties would bring some improvement on the survival of the patients with N3 left NSCLC without any preoperative treatments routinely.
    
    Results:
    Patients with p- N3α and N3γ (neck lymph node metastases case) cases have poor prognosis, and lung operation is not normally indicated. We have performed neck and bilateral mediastinal lymph node dissection by median sternotomy to resect lung cancer and dissect the bilateral mediastinal lymph nodes. We have performed this operation in 289 patients with primary left lung cancer excluding small cell carcinoma and stageIV since 1987. 42 patients had p-N3 lymph node metastases. We will report the investigation of the prognoses of left NSCLC patients who underwent initially our extended neck and bilateral mediastinal dissection, focused on the patients with N3 disease. According to the macroscopic dissection procedure, dissection of the lymphatics from the lungs to the supraclavicular lymph nodes was performed by sequential removal of the related organs. We systematically compared and reviewed the route of lymphatic communications to the neck and contra lateral side with the anatomical significance of left-to-right lymphatic communications in the bilateral mediastinal lymph nodes. The 5-year survival rate （Kaplan-Meier method）, including operative deaths and deaths due to unrelated diseases, was 48.8% in p-N3α、35.8% in N3γ.
    
    Conclusion:
    We found various lymphatic metastases pattern such as between neck and mediastinal lymph nodes and around the trachea in terms of clinical and anatomical status. Our surgical approach suggest the importance of the extend dissection by median sternotomy.