Abstract
BackgroundMediastinal lymph node dissection is an essential component of lung cancer surgery. Literature lacks established information regarding the number and size of the healthy lymph nodes. In this postmortem autopsy study, we aim to define the number, size and weight of the lymph nodes in each mediastinal lymph node station. To implement the data for the clinical practice, we analyzed the possible number of nodes to be dissected in a systematic mediastinal lymph node dissection from the right and left sides during lung cancer surgery.MethodsSixty-two samples obtained from cadavers who did not die from chest malignancies, extrathoracic malignancies, any kind of infections or previous hospitalization before the death were included to the study. The locations of the nodes were recorded according to the American Thoracic Society Mediastinal Lymph Node Map. The number, size and weight of the nodes were determined at each station.ResultsMedian age of the cadavers was 39 years. Primary causes of death were asphyxia in 10 (16.1%) subjects, trauma in 29 (46.8%) subjects, cardiovascular problems in 10 (16.1%) subjects, and undetermined in 13 (21%) subjects. The median number of lymph nodes resected from each patient was 23 (range: 11–54). The right sided paratracheal lymph nodes (Station 2R and 4R) were more frequent, heavier and longer than left sided lymph nodes (Station 2L and 4L) at the paratrecheal region. Right sided inferior mediastinal lymph nodes were heavier and longer than the left ones; however, their availability was more often on the left.ConclusionsThe properties of mediastinal lymph nodes at particular stations are different for number, size and weight. Station 4R and 7 have the highest number of nodes followed by stations 5 and 6. We recommend removing the lymph nodes of these stations completely in lung cancer patients to rule out the possibility of micrometastatic disease. Diameter of normal lymph node may be 1 cm for the stations other than 4R and 7, but the definition of normal diameter of a lymph node at the stations 4R and 7 may be changed as 1,5 cm and 2,0 cm, respectively. Weight of the nodes may be a new subject to study and may be defined as a new modality to define a staging to be more accurate and the issue needs further investigations.
Highlights
IntroductionLiterature lacks established information regarding the number and size of the healthy lymph nodes
Mediastinal lymph node dissection is an essential component of lung cancer surgery
There are only two randomized studies which state that these concerns are unfounded [3,5]; micrometastatic disease is diagnosed more accurately with the method [2,4] and in various nonrandomized comparative studies a survival benefit for mediastinal lymph node dissection (MLND) has been clearly shown [2,3]
Summary
Literature lacks established information regarding the number and size of the healthy lymph nodes In this postmortem autopsy study, we aim to define the number, size and weight of the lymph nodes in each mediastinal lymph node station. We hypothesized that the number and size of lymph nodes may be different in each particular lymph node station and standardization of lymph node dissection or sampling may require consideration on the original number, size and weight in the otherwise healthy, postmortem subjects. In this autopsy study, we aim to define the number, size and weight of the lymph nodes in each mediastinal lymph node station
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