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S. Saeteng
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OA 04 - Surgery from Minimal to Radical (ID 661)
- Event: WCLC 2017
- Type: Oral
- Track: Surgery
- Presentations: 1
- Moderators:J. Lee, A. Chang
- Coordinates: 10/16/2017, 15:45 - 17:30, Room 311 + 312
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OA 04.08 - Is Lobe-Specific Lymph Node Dissection in Clinical N0-1 Non-Small Cell Lung Cancer Adequate for Pathological Nodal Staging (ID 9714)
17:00 - 17:10 | Author(s): S. Saeteng
- Abstract
- Presentation
Background:
Lobe-specific lymph node dissection (L-SND) was proposed for clinical T1a-2b N0-1 non-small cell lung cancer (NSCLC), however, the benefit of this approach is still uncertain, especially for pathological nodal staging. In this study, we evaluated the percent detection of pN2 disease in L-SND and in systematic lymph node dissection (SLND).
Method:
From 2010 to 2016, 166 patients with cT1a-T2b N0-1 NSCLC underwent a lobectomy with SLND at Chiang Mai University Hospital. The pathologic results of the lymph nodes dissected in each station were extracted form medical records. Patients who underwent a SLND when then reclassified as L-SLN according to the site of the primary tumor; right upper lobe (station 2R-4R), left upper lobe (station 4L-6), and both lower lobes (station 7-9). Percent detection of pN2 disease was compared between L-SLN and SLND.
Result:
The rate of detection of pN2 in the SLND was higher than in the L-SLD, but the difference was not statistically significant (27.0 %versus 23.6%, p=0.474). The overall percent of cases upstaged to pN2 was only 4.4% after SLND; it was 4.4% in right upper lobe, 3.4 % in left lower lobe, 3.2 % in right lower lobe, and 1.9 % in left upper lobe (p=0.904). The pN2 disease detection agreement between L-SND and SLND was high (kappa=0.911 (95% CI; 0.784 - 0.957). Table 1 pathological N2 status in lobe-specific dissection and systematic lymph node dissectionLocation of primary tumor Clinical N0-1 status Pathologic N2 status (lobe-specific dissection) Pathologic N2 status (Systematic dissection) % upstaged to N2 disease Negative Positive Negative Positive Negative Positive RUL (n=67) 57 (85.1) 10 (14.9) 52 (77.6) 15 (22.4) 49 (73.1) 18 (26.9) 4.5 RLL (n=31) 29 (93.65) 2 (6.5) 24 (77.4) 7 (22.6) 23 (74.2) 8 (25.8) 3.2 LUL (n=51) 43(84.3) 8 (15.7) 37 (72.5) 14 (27.5) 36 (70.6) 15 (29.4) 1.9 LLL (n=29) 24 (82.8) 5 (17.2) 23 (79.3) 6 (20.7) 22 (75.9) 7 (24.1) 3.4
Conclusion:
These results suggest that lobe-specific lymph node dissection is as adequate as SLND for pathological N2 staging in clinically early stage NSCLC surgery. However, systematic lymph node dissection achieved a higher detection of pN2 disease. Further studies with a larger sample size are warranted to confirm these results.
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