Surgical Consideration Based on Lymph Nodes Spread Patterns in Patients with Peripheral Right Middle Non-small Cell Lung
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ORIGINAL SCIENTIFIC REPORT
Surgical Consideration Based on Lymph Nodes Spread Patterns in Patients with Peripheral Right Middle Non-small Cell Lung Cancer 3 cm or Less Rulan Wang1 • Han-Yu Deng1 • Jie Zhou1 • Rui Jiang1 • Qinghua Zhou1
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The optimal extent of lung resection and lymph nodes dissection for peripheral early-stage right middle non-small cell lung cancer (NSCLC) still remains controversial. In this study, we analyzed the patterns of lymph nodes metastasis (LNM) of patients with peripheral right middle NSCLC B 3 cm, aiming to provide evidences for surgical choice for early-stage peripheral right middle lobe NSCLC. Methods We retrospectively investigated the clinical and pathological data of patients diagnosed with peripheral right middle lobe NSCLC B 3 cm between January 2015 and December 2019. The LNM patterns were analyzed by tumor size. Results A total of 60 patients were included for analysis. The tumor size was preoperatively divided as follows: B 1 cm (13 patients); [ 1 cm but B 2 cm (36 patients); [ 2 cm but B 3 cm (11 patients). Fifty-four patients were categorized as N0 group, 1 patient as N1 group, and 5 patients as N2 group. In the upper zone, 3 patients were found to have LNM. In the subcarinal zone, another 3 patients had LNM. But the lymph nodes of all these patients were negative in the lower zone. In station 10, 1 patient (1.67%) was found to have LNM, while in station 11–13, 2 patients (3.33%) were found to have LNM. Conclusion For the right middle lobe peripheral NSCLC B 1 cm, sublobar resection with lymph node sampling may be a feasible treatment. For cancers [ 1 cm but B 2 cm, lobectomy with lobe-specific lymph node dissection (especially station 2R and 4R) may be a preferred choice. For tumors [ 2 cm but B 3 cm, lobectomy with systematic lymph node dissection may still be the standard of care.
Introduction
Rulan Wang and Han-Yu Deng contributed equally to the study and were co-first authors. & Han-Yu Deng [email protected] & Qinghua Zhou [email protected] 1
Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, People’s Republic of China
Lung cancer is one of the heaviest burdens of cancer worldwide and causes 1.6 million people death per year [1]. Surgery is the preferred treatment for early-stage nonsmall cell lung cancer (NSCLC) [2]. However, for the patterns of its lymph node metastasis (LNM) have not been fully elucidated, the extent of lymph node dissection and surgical resection of early-stage NSCLC remains controversial [3]. Previously, lobectomy with systematic lymph node dissection (SLND) or sampling is most commonly adopted [4]. With the wide application of low dose spiral computed tomography (CT), more and more NSCLC is
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found at the early stage [1], which makes sublobar resection receive more attentions [5]. Besides, accurate assessment of the pathological status of the lymph nodes is essential to guide the choice of surgical methods and
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