Abstract
BackgroundSystematic nodal dissection plays a crucial role in improving survival and staging in resectable non-small cell lung cancer (NSCLC) patients but at the cost of increasing the occurrence of recurrent laryngeal nerve injury. Technology should be improved to protect the recurrent laryngeal nerve (RLN) during surgery.MethodsNSCLC patients who underwent video-assisted thoracic surgery (VATS) surgical treatment by the same surgeon at our hospital from January 2016 to December 2017 were included as the research subjects and were divided into an energy-device group and a non-energy-device group. Their procedures included anatomic pulmonary resection, normative N1 dissection, and systemic N2 dissection.ResultsThe rate of metastatically involved recurrent laryngeal nerve lymph nodes (RLNLNs) was 5.19% (39/752). Dissection device, side of primary, FEV1, operative time and BMI were independent predictors of recurrent laryngeal nerve injury (RLNI) (hazard ratio (HR) = 3.576, 95% confidence interval (CI): 1.490–8.583, P = 0.004; HR = 0.175, 95% CI: 0.072–0.424, P = < 0.001; HR = 3.008, 95% CI: 1.30–6.927, P = 0.010; HR = 0.328, 95% CI: 0.136–0.794, P = 0.013; HR = 0.344, 95%CI: 0.147–0.801, P = 0.013, respectively). Patients in the non-energy-device group had significantly less RLNI than the energy-device group (P = 0.016) and nearly half of the non-thermal RLNI recovered in 2 weeks (P = 0.025) whereas most thermal RLNI required 3 months for recovery.ConclusionsEvery station of RLNLN had some degree of cancer metastasis in NSCLC patients and when dissecting RLNLNs, dissection device was an independent and artificially controlled predictor of RLNI. Using a non-energy device is a feasible method to protect the RLN as well as an improved recovery time of RLNI.
Highlights
Systematic nodal dissection plays a crucial role in improving survival and staging in resectable nonsmall cell lung cancer (NSCLC) patients but at the cost of increasing the occurrence of recurrent laryngeal nerve injury
The age, body mass index (BMI), forced expiratory volume in 1 s (FEV1), location of primary, lobar origin, stage, mean tumor diameter and blood loss between the two groups were not significantly different, whereas the operative time in the non-energy-device group was significantly lower than the energy-device group (P = 0.006)
Rate of metastatically involved recurrent laryngeal nerve lymph nodes (RLNLNs) Four RLNLN stations were dissected in all 188 patients for a total of 752 stations
Summary
Systematic nodal dissection plays a crucial role in improving survival and staging in resectable nonsmall cell lung cancer (NSCLC) patients but at the cost of increasing the occurrence of recurrent laryngeal nerve injury. Wen et al [5] provided evidence that at least 12 locations of lymph nodes should be examined to provide longer 5-year cancer specific survival and a significant reduction in disease recurrence in patients with T2N0 NSCLC. Even though there are alternative sampling technologies, such as EBUS-TBNA and mediastinoscopy, a Dutch study showed that increased usage of less invasive endosonography prior to or even substituting for surgical staging did not uncover unexpected cases of N2 nodal disease in NSCLC [7], the greater the number of resected lymph nodes, the less likely N1 or N2 disease would be incorrectly diagnosed as N0 [5]. In Lius study, the incidences of upstaging from N0 to N1 and N2 disease were 7.7% and 12.2% utilizing SND [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
