Outcomes of unexpected pathologic N2 disease after total video-assisted thoracic surgery lobectomy for non-small cell lung cancer
10.3760/cma.j.issn.1001-4497.2012.02.007
- VernacularTitle:术后病理N2(ⅢA)期非小细胞肺癌的全胸腔镜肺叶切除术疗效
- Author:
Yingtai CHEN
;
Yuqing HUANG
;
Yun LI
;
Luming JIN
;
Jian CUI
;
Jun LIU
;
Jun WANG
- Publication Type:Journal Article
- Keywords:
Lung cancer;
VATS lobectomy;
Clinical stage Ⅰ;
N2 disease;
Prognosis
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2012;28(2):86-89
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess early and medium outcomes of pathologic N2 disease unexpectedly detected in patients undergoing total video-assisted thoracic surgery lobectomy for non-small cell lung cancer.Methods Between Sep.2006 and Dec.2010,348 patients with Non-small cell lung cancer underwent total video-assisted thoracic surgery lobectomy,and within them,35( 10.1％ ) were found to have pathologic N2 disease after operation.We retrospectively reviewed the clinical and pathologic features of patients with unexpected N2 disease after video-assisted thoracic surgery lobectomy and their early and medium outcomes,including survival and recurrence pattern.Results No perioperative mortality was noted.26 patients received a lobectomy directly,and the other 9 patients after a wedge resection.All the patients had R0 resection.The medium operation time was 190 minutes and medium blood loss was 200ml.The medium stations and numbers of dissected N2 lymph nodes in operation were 4 and 10,respectively.And the medium stations and numbers of metastatic N2 Lymph nodes were 1 and 2,respectively.Among patients with pathologic N2 disease,18 (51.4％) had single-station involvement.The median duration of chest tube placement was 8 days.The median length of hospital stay was 11 days.15 complications occurred in 12 (34.3％) patients.All of the patients underwent adjuvant chemotherapy with platinum postoperatively.The median follow-up time was 23 months.The 1 - and 2-year overall survival (OS) was 80.9％ and 67.9％,and the medium OS was not reached.During follow-up,16 (45.7％) patients had a recurrence.The pattern of recurrence was locoregional in 5,distant in 11.The 1 - and 2-year disease-free survival (DFS) was 71.9％ and 44.2％,and the medium DFS was 20 months (95％,8.1 to 31.9 months).Divided the patients with pathologic N2 disease into two groups considering single-station involvement or not,the 1-and 2-year OS and DFS for the single-station group and for the multiple-station group were 87.7％,78.9％ ; 88.9％,49.4％and 67.6％,59.1％ ; 55.3％,39.5％.The medium DFS for both the two groups was 23 and 16 months respectively.Conclusion For non-small cell lung cancer with N0 disease confirmed by an exactly preoperative staging workups,if it is feasible in technology,a total video-assisted thoracic surgery lobectomy should be recommended.Even if N2 lymph node metastasis is unexpectedly detected postoperatively,the metastasis was mostly micro- or single-station involved,and a similar outcome with conventional thoracotomy can be achieved.
