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Alan D L Sihoe
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P1.16 - Surgery (ID 702)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.16-009 - Comparing Lymph Node Dissection in VATS versus Open Lung Cancer Surgery: How, How Long, and How Does It Matter? (ID 8783)
09:30 - 09:30 | Presenting Author(s): Alan D L Sihoe
- Abstract
Background:
Adequacy of lymph node dissection is often used to compare video-assisted thoracoscopic surgery (VATS) with open surgery for lung cancer, but no consensus exists over how best to assess nodal yield (by weighing or counting) and to correlate this with survival. This study uses one of the longest follow-up periods to date to address these unanswered questions.
Method:
From February 2006 to July 2010, 230 consecutive adult patients with non-small cell lung cancer received lobectomy with curative intent. Surgical approach was determined by the surgeon’s discretion: 118 (51%) ultimately received VATS and 112 (49%) received open or ‘hybrid’ surgery.
Result:
A summary of the data is shown in the Table. Mean numbers and weights of lymph nodes dissected in the two study arms were similar overall, but VATS yielded more in stations 3 and 7, and non-VATS in station 10. A change in staging was more frequent after non-VATS, but was due mostly to more downstaging. VATS more frequently fulfilled the European Society of Thoracic Surgeons (ESTS) guidelines for adequacy of nodal dissection. Previous tuberculosis reduced nodal yields with non-VATS (p=0.033) but not VATS. On regression analysis, the counted numbers of nodes dissected correlated well with the measured weights in both VATS and non-VATS groups (F ratios: 26.0, p<0.001 and 58.6, p<0.001 respectively). VATS gave a trend for better 5-year overall survival in stage I disease (p=0.108). No significant correlation was found between nodal dissection, surgical approach and survival after a median postoperative follow up of 111 months (range: 82-136), but 33 (26.4%) of the 125 total deaths occurred after 5 years. Figure 1
Conclusion:
Counting and weighing give similar results for comparing lymph node yields after VATS versus non-VATS. VATS gives non-inferior nodal yields, but follow-up for longer than the conventional 5 years may be potentially important in correlating yields with long-term survival.
