A Retrospective Review Of74Non-small Cell Lung Cancer Patients

Objective:To establish the optimal surgical strategy, we retrospectivelyanalyzed the efficacy of computed tomography (CT), lobe specific patterns ofnodal spread with mediastinal involvement, feasibility of systematic nodedissection by VATS and differences between the sixth internationaltumor-node-metastasis (TNM,1997) staging system and the seventh system(2009).Methods: A single-center retrospective analysis was performed on thedata of74non-small cell lung cancer patients that underwent lung resectionand systematic lymph node dissection with curative intent between April2011and December2011in the fourth hospital of hebei medical university fifthdepartment of thoracic surgery. An Excel database was built with lymph nodesinvolvement and stages according to the TNM staging systems.To compare The patients in Ⅰ, Ⅱ, Ⅲ and Ⅳ according tothe sixthinternational tumor-node-metastasis (TNM,1997) staging system with theseventh system (2009),we show the differences with a graph based on SPSSsoftware.Preoperative computed tomography (CT)-based clinical staging wascompared with surgical-pathological staging. Lymph nodes with a shortestdiameter of over1cm on CT were considered abnormal, but did notcontraindicate surgery.Spss17.0software package was used to tabulate the patients and lymphnodes in every group,as superior lobe of left lung and middle lobe of rightlung, squamous cell carcinoma and adenocarcinoma,cTNM and pTNM,OTand OVAT,then we explore the patterns of nodal spread and feasibility ofsystematic node dissection by VATS.Results:1There was no defferences between the two TNM systems in the patients ofⅠa,Ⅱa and Ⅲa.14(14/21,67%)cases in Ⅰ b,4(4/10,40%)cases in Ⅱband3(3/4,75%)cases in Ⅲb were accordant according to the two systems.2To study the Mediastinal spread patterns of metastatic lymph nodes inbronchogenic carcinoma, a calculation of lymph nodes from mediastinalnode stations according to difference lobes was analyzed. The Inferiormediastinal node (stations2,3, and4) involvement occurred to superiorlobe of right lung mostly, and the lymph nodes of station5and6must bedetected for superior lobe of left lung, subcarinal nodes (station7)involvement happened to all the lobes.3Forty-one percent (30/74) had squamous cell carcinoma, and50%(37/74)had adenocarcinoma. There was21%of nodes dissected involved foradenocarcinoma,and8%for Squamous cell carcinoma.4The sensitivity for Ⅰa on CT was82%, and the spesificity was94%,theaccuracy,91%. The sensitivity, spesificity and accuracy for Ⅰ b,Ⅱ a, Ⅱband Ⅲa were86%,95%,93%;43%,92%,82%;40%,97%,93%and87%,85%,85%. Skip N2metastases without any N1involvement werefound in27%(8/30) of metastases cases. The clinical stage was correct in69%(51/74). The sensitivity of lymph node metastasis on CT was73%,and the specificity was80%,the accuracy,77%.5The total number of nodes dissected (VATS156vs OT583), stations ofnodes dissected (VATS60vs OT208), N of dissected nodes inaverage(VATS6.8vs OT11.4) and syations of dissected nodes inaverage(VATS2.6vs OT4.1)were different between the two groups. Therewere no operation related deaths in the VATS group and open thoracotomygroup.In the cases of Ⅰstage, the number of dissected nodes inaverage(OT8.1vs OVAT6.4) and syations of dissected nodes inaverage(OT3.2vs OVAT2.5)were similar between the two groups.Conclusions:1. There are19%(14/74)of the patients defined differently according to thesixth and seventh systems because of the changes on the size of tumor andmalignant thoracic wall nodules. 2. Subcarinal nodes (station7) must be resected during the operationregardless of the tumor location. the absence of metastases to hilar lymphnodes is not always connected with the absence of metastases tomediastinal lymph nodes. The Inferior mediastinal node involvementoccurred to superior lobe of right lung, and the lymph nodes of station5and6must be detected for superior lobe of left lung. The nodes of station13and14must be dissected.3. The majority50%(37/74) of74non-small cell lung cancer patients wereadenocarcinoma, and showed multiple-level mediastinal invol-vement,even in cN0patients. Adenocarcinoma is a risk factor for nodal spreadwith mediastinal involvement.4. The clinical TNM and staging based on CT are inaccurate. Evaluatinginfiltration into adjacent structures and nodal spread is unreliable with CT,as was studied. Computed tomography (CT) is useful inⅠ a cases.5. The systematic node dissection by VATS was as technically feasible assystematic node dissection through OT regarding number of dissectednodes for stage I lung cancer. It seems acceptable as an oncologicaltreatment for NSCLC,but needs more improvement.