The Clinical Value Of Tunnel-type En Bloc Mediastinal Lymph Node Dissection In Video-assisted Thoracic Surgery For Right Lung Cancer Radical Resection

Objective: To evaluate the safety,thoroughness,efficacy and feasibility of the video-assisted thoracic surgery(VATS)tunnel-type En bloc mediastinal lymph node dissection in the 2R,4R and 7 groupsfor right lung cancer radical resection.Methods: A retrospective study was performed in the clinical data of 196 patients who underwent VATS right lung cancer radical surgery between Jan.2013 and Dec.2015,which was diagnosed with right non-small cell lung cancer(NSCLC)at the Fujian Medical UniversityUnion Hospital.According to the different surgical methods of lymph node dissection in the 2R,4R and 7 groups,they were divided into tunnel-type group(n = 102)and conventional group(n = 94).And the lymph node dissection of each group was systemic lymphadenectomy.The perioperative indexes,the number of lymph node dissection,the incidence of postoperative complications and postoperative survival rate were compared between the two groups.Results: The two groups of patients were successfully completed surgical treatment,And No bleeding due to cleaning lymph nodes of the 2R,4R and 7 groups,no deaths occurred perorpemtively in the two group.There were no significant difference in the operative time and mediastinal lymph node of N2 group dissection time between the two groups(P> 0.05).However,the intraoperative blood loss,postoperative thoracic drainage,postoperative extubation time and postoperative hospital stay were significantly lower in the tunnel group than those in the conventional group,and the postoperative pulmonary infection rate was lower than that of the conventional group,which Were statistically significant(P <0.05).For all patients or the postoperative pathological T1-4N2M0 patients with 2R,4R and 7 lymph nodes dissection,there was statistical analysis,which shows that the total count of lymph node dissection,the number of positive lymph node,the lymphatic metastasisrate and the lymphatic metastatic incidence were all comparable between the two groups(P> 0.05).The 2-year survival rate was 98.6% in tunnel-type group,92.3% in conventional group,respectively(P=0.062).The 2-year overall recurrence and metastasis rate was 5.5% VS 17.0%,respectively(P=0.053).And subgroup analysis of patients with positive lymph node in N2 group,there was no significant difference in the 2-year recurrence and metastasis rate and survival rate between the two groups(P> 0.05).Conclusions: Tunnel-type En Bloc mediastinal lymph node dissection can complete similarly qualitative and standard mediastinal lymph node dissection of N2 group.However,compared with conventional mediastinal lymph node dissection,there are advantages,such as smaller surgical trauma,shorter postoperative hospital stay,rapid postoperative rehabilitation and so on.Therefore,we believe that the tunnel-type En bloc mediastinal lymph node dissection is a safe,thorough,effective and feasible surgical approach,which is worthy of VATS for right lung cancer radical surgery.