MS06.05 Transcervical Lymphadenectomies

Abstract

Introduction: The aim of his study is to analyze the issue of transcervical lympadenectomies for Non-Small-Cell Lung Cancer performed by the techniques of Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA) and Transcervical Extended Mediastinal Lymphadenectomy (TEMLA). Methods The Pubmed search was performed and there were 27 articles found on VAMLA and 33 articles on TEMLA. After further analysis there were 13 original article on VAMLA and 18 original articles on TEMLA. In the current paper all proven and possible advantages of transcervical lymphadenectomies represented by VAMLA and TEMLA are described. Results The proven advantages of VAMLA and TEMLA: 1. Superior diagnostic value in discovery of the metastatic mediastinal nodes for staging and restaging of NSCLC. 2. bilateral mediastinal lymphadenectomy, more extensive than the techniques of lymphadenectomy used during standard thoracotomy or Video-Assisted Thoracic Surgery (VATS) approaches. Possible advantages include: 1. Improved selection of patients for pulmonary resection for NSCLC 2. Combination of VAMLA/TEMLA with VATS pulmonary resection, 3. Combination of VAMLA/TEMLA with esophegeal resection, 4. Combination of TEMLA and Stereotactic Radiotherapy (SBRT) for advanced NSCLC 5. The use of TEMLA for preoperative staging of mesothelioma, 6. Combination of TEMLA and pulmonary lobectomy through a sole transcevical approach 7. Resection of various metastatic tumors, including thyroid cancer and metastatic mediastinal nodes. 8. Possible impact of VAMLA/TEMLA on improvement of survival for NSCLC patients, which is the most important issue. In case of VAMLA superior survival of patients operated on with the use pulmonary resection with VAMLA in comparison to the pulmonary resection with addition of standard mediastinoscopy. In case of TEMLA no reports on survival has been published, yet Disadvantages of VAMLA/TEMLA include 1. Possible complications, especially the left recurrent nerve palsy 2. Possible delay or elimination of some patients from pulmonary resection due to postoperative complication in case of negative result of VAMLA/TEMLA 3. Scar in the neck (cosmetic) 4. Demanding surgical technique Conclusions 1. Bilateral transcervical lymphadenectomies representd by VAMLA and TEMLA are more extensive than the techniques of lymphadenectomy used during standard thoracotomy or Video-Assisted Thoracic Surgery (VATS) approaches and superior to the other techniques of staging and restaging of NSCLC in regard to the diagnostic value. 2. There are several other possible advantages of TEMLA/VAMLA for the treatment of NSCLC, esophageal cancer, mediastinal tumors and malignant mesothelioma. 3. Possible impact of VAMLA/TEMLA on survival of NSCLC has not been proven, yet. References Hurtgen M, Friedel G, Toomes H et al: Radical video-assisted mediastinoscopic lymphadenectomy (VAMLA) – technique and first results. 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