Mediastinal lymph node evaluation, especially at station 4L, in left upper lobe lung cancer
2022 Journal of Thoracic Disease. All rights reserved..
Background: Mediastinal lymph node (LN) dissection during lung resection is essential for accurate staging. Station 4L dissection is anatomically difficult. Therefore, care should be taken to avoid complications. We investigated the importance of mediastinal LN dissection in left upper lobe lung cancer and evaluated intraoperative videos to identify relevant steps during dissection.
Methods: We retrospectively reviewed 151 consecutive patients with left upper lobe lung cancer. Finally, 139 patients were enrolled to examine the survival effects of clinical factors of metastatic LN stations. The association between risk factors or surgical procedures and recurrent laryngeal nerve palsy was analyzed.
Results: LN dissection of the left upper lobe revealed station 4L LN metastasis in nine patients, three of whom were node-negative on mediastinoscopy. Station 4L LN status was confirmed intraoperatively in 12 of 33 patients. Twenty patients had recurrent laryngeal nerve palsy, four of whom were complicated with aspiration pneumonia. Station 4L LN dissection was an independent risk factor for recurrent laryngeal nerve palsy (P=0.03). The use of an energy device near the recurrent laryngeal nerve was a significant risk factor for recurrent laryngeal nerve palsy. Incidentally, pathological N stage ≥2 was an independent prognostic factor for disease-free survival (DFS) (P=0.005) herein.
Conclusions: In patients with left upper lobe lung cancer, pathological N2 disease is an important predictor of recurrence. Therefore, accurate mediastinal LN dissection, including at station 4L, should be performed. We propose to standardize the dissection procedure at each institution to avoid complications, such as recurrent laryngeal nerve palsy.
| Errataetall: |
CommentIn: J Thorac Dis. 2023 Jan 31;15(1):14-16. - PMID 36794136 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:14 |
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| Enthalten in: |
Journal of thoracic disease - 14(2022), 9 vom: 19. Sept., Seite 3321-3334 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hanaoka, Jun [VerfasserIn] |
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| Links: |
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Journal Article |
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| Anmerkungen: |
Date Revised 16.02.2023 published: Print CommentIn: J Thorac Dis. 2023 Jan 31;15(1):14-16. - PMID 36794136 Citation Status PubMed-not-MEDLINE |
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| doi: |
10.21037/jtd-22-537 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM347605915 |
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| 245 | 1 | 0 | |a Mediastinal lymph node evaluation, especially at station 4L, in left upper lobe lung cancer |
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| 500 | |a Date Revised 16.02.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: J Thorac Dis. 2023 Jan 31;15(1):14-16. - PMID 36794136 | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a 2022 Journal of Thoracic Disease. All rights reserved. | ||
| 520 | |a Background: Mediastinal lymph node (LN) dissection during lung resection is essential for accurate staging. Station 4L dissection is anatomically difficult. Therefore, care should be taken to avoid complications. We investigated the importance of mediastinal LN dissection in left upper lobe lung cancer and evaluated intraoperative videos to identify relevant steps during dissection | ||
| 520 | |a Methods: We retrospectively reviewed 151 consecutive patients with left upper lobe lung cancer. Finally, 139 patients were enrolled to examine the survival effects of clinical factors of metastatic LN stations. The association between risk factors or surgical procedures and recurrent laryngeal nerve palsy was analyzed | ||
| 520 | |a Results: LN dissection of the left upper lobe revealed station 4L LN metastasis in nine patients, three of whom were node-negative on mediastinoscopy. Station 4L LN status was confirmed intraoperatively in 12 of 33 patients. Twenty patients had recurrent laryngeal nerve palsy, four of whom were complicated with aspiration pneumonia. Station 4L LN dissection was an independent risk factor for recurrent laryngeal nerve palsy (P=0.03). The use of an energy device near the recurrent laryngeal nerve was a significant risk factor for recurrent laryngeal nerve palsy. Incidentally, pathological N stage ≥2 was an independent prognostic factor for disease-free survival (DFS) (P=0.005) herein | ||
| 520 | |a Conclusions: In patients with left upper lobe lung cancer, pathological N2 disease is an important predictor of recurrence. Therefore, accurate mediastinal LN dissection, including at station 4L, should be performed. We propose to standardize the dissection procedure at each institution to avoid complications, such as recurrent laryngeal nerve palsy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Lung cancer | |
| 650 | 4 | |a lymph node (LN) | |
| 650 | 4 | |a lymph node dissection | |
| 650 | 4 | |a recurrent laryngeal nerve palsy | |
| 650 | 4 | |a video-assisted thoracoscopic surgery | |
| 700 | 1 | |a Yoden, Makoto |e verfasserin |4 aut | |
| 700 | 1 | |a Okamoto, Keigo |e verfasserin |4 aut | |
| 700 | 1 | |a Kaku, Ryosuke |e verfasserin |4 aut | |
| 700 | 1 | |a Ohshio, Yasuhiko |e verfasserin |4 aut | |
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