Comparison Of Lymph Node Dissection And Lymph Node Sampling For Non-small Cell Lung Cancers By Video-assisted Thoracicscope Surgery

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The risk factors of mediastinal lymph node metastasis in all lung cancers[Objective] The risk factors of N2 disease in lung cancers were still controversial.The aim of this study is to analyze the risk factors of N2 disease in lung cancers.[Methods] Consecutive patients with primary resectable lung cancers referred for lobectomy and lymph node dissection or sampling by VATS between January 2012 and December 2016 were retrospectively reviewed.Clinicopathological characteristics and perioperative results were collected for statistical analysis.[Results] Seven-hundred and seventy-three VATS lobectomy patients were included in this study.There are 101 paitents with positive N2 lymph node while 672 patients with negative N2 lymph node.There were more male patients,left side tumors with lymph node dissection in the LND group than in the LNS group.Multivariate analysis suggested that higher tumor T categories and systemic lymph node dissection were independent risk factors for N2 diseases in all lung cancers,while higher tumor T categories,histological subtypes,and extent of lymphadenectomy were independently related to N2 stage in adenocarcinomas.[Conclusions] Lymph node dissection may upstage N classification in patient with NSCLC andshould be recommended in patients with tumors in higher T categories or with more invasive histologyPart ? Comparison of lymph node dissection and lymph node sampling for non-small cell lung cancers by video-assisted thoracoscope surgery[Objective] Few studies had been performed to compare mediastinal lymph node dissection(LND)and lymph node sampling(LNS)by video-assisted thoracoscope surgery(VATS)for non-small cell lung cancer.The aim of this study is to figure out whether LND by VATS is safe and feasible.[Methods] We retrospetivly analyzed patients with primary resectable lung cancers referred for lobectomy and lymph node dissection or sampling by VATS between January 2012 and December 2016.Clinicopathological characteristics and perioperative results were collected for statistical analysis.[Results] Seven-hundred and seventy-three VATS lobectomy patients were included in this study,494 received LND and 279 received LNS.There were more male patients,higher T and N stage in the LND group than in the LNS group.No significance difference was observed in age,gender,co-morbidity,tumor location,or T stage between two groups after propensity-score matching.The LND group had longer operative time(128 minutes vs.114 minutes,p<0.001),higher amount of postoperative drainage(920 ml vs.720 ml,p<0.001),longer postoperative hospital stay(6 days vs.4 days,p<0.001)than the LNS group.But no difference was observed in overall morbidity or mortality between the two groups.[Conclusions] Lymph node dissection by VATS has acceptable perioperative results but can provide more accurate nodal staging compared with lymph node sampling.Lymph node dissection by VATS is safe,feasible.Part ? Establishment of diagnostic criteria for pherenic nerve injury by chest X-Ray after lobectomy[Objective] Making a clear-cut diagnosis is not always easy with routine methods.The aim of our study is to find an easily accessible and precise way to diagnose PNI[Methods] The extent of diaphragm elevation was examined in patients with invasive thymomas in whom phrenic nerve was certainly divided.The distance between the diaphragm and the apex of the chest was calculated on chest X-Ray before(DB: Distance before)and after(DA: Distance after)surgery.The following formula was used: [(DB-DA)/DB] ×100%.[Results] Diaphragm elevation was found to be 24.24 6.2% in 22 invasive thymoma-patients and 30% was adopted as criteria to diagnose PNI in lung cancer patients undergone minimally invasive lobectomy.[Conclusions] We found a precise and easily accessible way to diagnose PNI in lung cancer patients undergone VATS lobectomy.Part ? The incidence and impact of phrenic nerve injury in lung cancer patients undergone minimally invasive lobectomy[Objective] Phrenic nerve injury(PNI)during lung cancer surgery,without apparent nerve section or damage,is still not well-studied.The aim of our study is to evaluate its incidence and impact in lung cancer patients undergone minimally invasive lobectomy.[Methods] The result(mean +SD)in previous study was then used as a criteria to diagnose PNI in lung cancer patients undergone VATS lobectomy and to study its effect on perioperative outcomes and spirometry change after surgery.[Results] Among 753 consecutive VATS lobectomy patients with lung cancer 56(7.4%)were diagnosed to have PNI.And it was more commonly seen after upper lobectomies than lower lobectomies(9% vs 5.5%,p=0.073).Although no difference in postoperative complications or length of hospital stay was found,reduction in FEV1(36.1 ± 19.5% vs 19.5% ± 16,7%,p<0.001),FVC(35.3% ± 19.1% vs 17.4% ± 14.6%,p<0.001),and DLCO(22.5% ± 9.7% vs 14.9% ± 12.1%,p<0.001)6 months after surgery was significantly greater in patients with PNI than those without.[Conclusions] Inadvertent PNI during minimally invasive surgery seems to be underestimated,and should be brought to attention as it is associated with significant reduction in pulmonary function.