Nodal management and upstaging of disease: initial results from the Italian VATS Lobectomy Registry. Imprimer
Mardi, 29 Août 2017 07:18
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Nodal management and upstaging of disease: initial results from the Italian VATS Lobectomy Registry.

J Thorac Dis. 2017 Jul;9(7):2061-2070

Authors: Bertani A, Gonfiotti A, Nosotti M, Ferrari PA, De Monte L, Russo E, Di Paola G, Solli P, Droghetti A, Bertolaccini L, Crisci R, Italian VATS Group

Abstract
BACKGROUND: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies.
METHODS: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies.
RESULTS: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98].
CONCLUSIONS: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.

PMID: 28840007 [PubMed]


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