What are the Survival Factors in Surgically Resected Synchronous Multiple Primary Lung Cancers: A Retrospective Study

The extent of mediastinal lymph node assessment during surgery for non-small cell cancer remains controversial. Different techniques are used, ranging from simple visual inspection of the unopened mediastinum to an extended bilateral lymph node dissection. Furthermore, different terms are used to define these techniques. Sampling is the removal of one or more lymph nodes under the guidance of pre-operative findings. Systematic (full) nodal dissection is the removal of all mediastinal tissue containing the lymph nodes systematically within anatomical landmarks. A Medline search was conducted to identify articles in the English language that addressed the role of mediastinal lymph node resection in the treatment of non-small cell lung cancer. Opinions as to the reasons for favoring full lymphatic dissection include complete resection, improved nodal staging and better local control due to resection of undetected micrometastasis. Arguments against routine full lymphatic dissection are increased morbidity, increase in operative time, and lack of evidence of improved survival. For complete resection of non-small cell lung cancer, many authors recommend a systematic nodal dissection as the standard approach during surgery, and suggest that this provides both adequate nodal staging and guarantees complete resection. Whether extending the lymph node dissection influences survival or recurrence rate is still not known. There are valid arguments in favor in terms not only of an improved local control but also of an improved long-term survival. However, the impact of lymph node dissection on long-term survival should be further assessed by large-scale multicenter randomized trials.

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What Are the Survival Factors in Surgically Resected Synchronous Multiple Primary Lung Cancers: A Retrospective Study

10.21203/rs.3.rs-135673/v1 ◽

2020 ◽

Author(s):

Haichao Li ◽

Kai Wang ◽

Xingxing Zhang ◽

Rong Chen ◽

Jian Zhao

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Lymph Node ◽

Independent Risk Factor ◽

Complete Resection ◽

Tnm Stage ◽

Smoking History ◽

Node Dissection ◽

Multiple Primary ◽

Independent Risk Factors

Abstract BackgroundWith the popularization of high-resolution computed tomography (HRCT), the detection rate of synchronous multiple primary lung cancer (SMPLC) is increasing. We retrospectively analyzed the surgical results of SMPLC patients in our hospital to determine the best treatment, surgical prognosis and survival analysis.MethodsA total of 78 SMPLC patients met the diagnostic criteria underwent complete resection and lymph node dissection or sampling without any preoperative induction therapy in the Department of Thoracic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University. We analyzed the postoperative survival rate, and further studied the relationship between survival rates and sex, age, preoperative symptoms, tumor location, tumor number, tumor size, lymph node metastasis, TNM stage, surgical type, surgical frequency, histopathologic types, vascular infiltration, visceral pleural invasion and postoperative therapy.ResultsAmong 78 patients, the 1-,2-,3-,4- and 5-year disease free survival (DFS) rates were 93.42%, 86.84%, 77.78%, 62.96%, and 60.00%, respectively, while the 1-,2-,3-,4- and 5-year overall survival (OS) rates were 94.73%, 92.11%, 82.22%, 77.78%, and 65.00%, respectively. TNM stage of the largest tumor (II:HR=7.40,III:9.01,p=0.002) was an independent risk factor for DFS. Smoking history (HR=4.34,p=0.039) and TNM stage of the largest tumor (II:HR=9.38,III:9.42,p=0.003) were independent risk factors for overall survival.ConclusionsFirst, SMPLC is different from intrapulmonary metastasis and its clinical stage is also different from the 8th (2015) edition TNM classification for lung cancer. Second, when pulmonary function permits, surgery (complete resection and lymph node dissection) is a significantly beneficial treatment for patients with SMPLC. Third, TNM stage of the largest tumor (II:HR=7.40,III:9.01,p=0.002) was an independent risk factor for DFS. Smoking history (HR=4.34,p=0.039) and TNM stage of the largest tumor (II:HR=9.38,III:9.42,p=0.003) were independent risk factors for overall survival.

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Sampling versus systematic full lymphatic dissection in surgical treatment of non-small cell lung cancer

Oncology Reviews ◽

10.4081/oncol.2013.e2 ◽

2013 ◽

Vol 7 (1) ◽

pp. 2 ◽

Cited By ~ 2

Author(s):

Georgios Koulaxouzidis ◽

Grigorios Karagkiouzis ◽

Marios Konstantinou ◽

Ioannis Gkiozos ◽

Konstantinos Syrigos

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Small Cell Lung Cancer ◽

Lymph Node Dissection ◽

Cell Lung Cancer ◽

Complete Resection ◽

Small Cell ◽

Node Dissection ◽

Small Cell Lung ◽

Term Survival

The extent of mediastinal lymph node assessment during surgery for non-small cell cancer remains controversial. Different techniques are used, ranging from simple visual inspection of the unopened mediastinum to an extended bilateral lymph node dissection. Furthermore, different terms are used to define these techniques. Sampling is the removal of one or more lymph nodes under the guidance of pre-operative findings. Systematic (full) nodal dissection is the removal of all mediastinal tissue containing the lymph nodes systematically within anatomical landmarks. A Medline search was conducted to identify articles in the English language that addressed the role of mediastinal lymph node resection in the treatment of non-small cell lung cancer. Opinions as to the reasons for favoring full lymphatic dissection include complete resection, improved nodal staging and better local control due to resection of undetected micrometastasis. Arguments against routine full lymphatic dissection are increased morbidity, increase in operative time, and lack of evidence of improved survival. For complete resection of non-small cell lung cancer, many authors recommend a systematic nodal dissection as the standard approach during surgery, and suggest that this provides both adequate nodal staging and guarantees complete resection. Whether extending the lymph node dissection influences survival or recurrence rate is still not known. There are valid arguments in favor in terms not only of an improved local control but also of an improved long-term survival. However, the impact of lymph node dissection on long-term survival should be further assessed by large-scale multicenter randomized trials.

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Morbidity, Survival, and Site of Recurrence After Mediastinal Lymph-Node Dissection Versus Systematic Sampling After Complete Resection for Non-Small Cell Lung Cancer

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2005.02.005 ◽

2005 ◽

Vol 80 (1) ◽

pp. 268-275 ◽

Cited By ~ 97

Author(s):

Didier Lardinois ◽

Hans Suter ◽

Hassan Hakki ◽

Valentin Rousson ◽

Daniel Betticher ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Small Cell Lung Cancer ◽

Lymph Node Dissection ◽

Mediastinal Lymph Node ◽

Complete Resection ◽

Small Cell ◽

Systematic Sampling ◽

Node Dissection ◽

Small Cell Lung

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Strategies for chylothorax after pulmonary resection and lymph node dissection for primary lung cancer

10.21203/rs.3.rs-274275/v1 ◽

2021 ◽

Author(s):

Yoshiyuki Yasuura ◽

Hayato Konno ◽

Takamitsu Hayakawa ◽

Yukihiro Terada ◽

Kiyomichi Mizuno ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Conservative Treatment ◽

Lymph Node Dissection ◽

Mediastinal Lymph Node ◽

Primary Lung Cancer ◽

Node Dissection ◽

Low Fat ◽

Drainage Volume ◽

Low Fat Diet

Abstract Background: Pulmonary resection with mediastinal lymph node dissection for treating primary lung cancer could sometimes causes chylothorax as a postoperative complication. This study examined the validity of treatments for chylothorax in our hospital.Methods: We evaluated 2,019 patients who underwent lobectomy, bilobectomy, or pneumonectomy with mediastinal lymph node dissection for primary lung cancer at Shizuoka Cancer Center Hospital, Shizuoka, Japan, between September 2002 and March 2018. The diagnostic criteria for postoperative chylothorax were that the drainage from the pleural drain was evidently white and turbid, or the pleural effusion contained a triglyceride level of >110 mg/dL. The clinical courses and treatments were retrospectively reviewed.Results: Postoperative chylothorax occurred in 37 patients (1.8%), 20 men and 17 women, with a median age of 70 y (33 to 80). Thirty-five patients had a lobectomy and two patients had a bilobectomy. A low-fat diet was instituted to all patients; 35 cases improved with conservative treatment, and 2 cases required reoperation. Nine cases had a drainage volume ≥ 500 ml one day following the low-fat diet commencement, which was resolved with conservative treatment and decreased drainage was observed on the third day of treatment in seven of those cases.Conclusions: With the exception of cases with excessive drainage of ≥ 1000 mL in one day and systemic symptoms associated with chyle loss, conservative treatment could be successful even when the daily drainage volume exceeds 500 mL following a low-fat diet, provided the drainage volume decreases within three days.

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