Retrospective Analysis of Nodal Spread Patterns According to Tumor Location in Pathological N2 Non‐small Cell Lung Cancer

Yoshihisa Shimada,Naohiro Kajiwara,Masatoshi Kakihana,Hisashi Saji,Jitsuo Usuda,Tatsuo Ohira,Norihiko Ikeda,Hidetoshi Honda

doi:10.1007/s00268-012-1743-5

Yoshihisa Shimada, Naohiro Kajiwara + Show 6 more

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https://doi.org/10.1007/s00268-012-1743-5

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Abstract

BackgroundThe purpose of the present study was to determine the nodal spread patterns of pN2 non-small cell lung cancer (NSCLC) according to tumor location, and to attempt to evaluate the possible indications of selective lymph node dissection (SLND).MethodsWe retrospectively analyzed nodal spread patterns in 207 patients with NSCLC of less than 5 cm with N2 involvement.ResultsThe tumor location was right upper lobe (RUL) in 79, middle lobe in 12, right lower lobe (RLL) in 40, left upper division (LUD) in 41, lingular division in 11, and left lower lobe (LLL) in 24. Both RUL and LUD tumors showed a higher incidence of upper mediastinal (UM) involvement (96 and 100 %, respectively) and a lower incidence of subcarinal involvement (15 and 10 %, respectively) than lower lobe tumors (UM; RLL 60 %, LLL 42 %; subcarinal: RLL 60 %, LLL 46 %, respectively). Among the patients with 24 right UM-positive RLL and 10 left UM-positive LLL tumors, 2 showed negative hilar, subcarinal, and lower mediastinal involvement, and cT1, suggesting that UM dissection may be unnecessary in lower lobe tumors with no metastasis to hilar, subcarinal, and lower mediastinal nodes on frozen sections according to the preoperative T status. Among the patients with 12 subcarinal-positive RUL and 4 subcarinal-positive LUD tumors, one showed negative hilar or UM involvement, suggesting that subcarinal dissection may be unnecessary in RUL or LUD tumors with no metastasis to hilar and UM nodes on frozen sections.ConclusionsThe present study appears to provide one of the supportive results regarding the treatment strategies for tumor location-specific SLND.

Highlights

Lobectomy with systematic mediastinal lymph node dissection (LND) has been considered the standard of care for resectable non-small cell lung cancer (NSCLC)
Among the patients with 24 right upper mediastinal (UM)-positive right lower lobe (RLL) and 10 left UM-positive left lower lobe (LLL) tumors, 2 showed negative hilar, subcarinal, and lower mediastinal involvement, and cT1, suggesting that UM dissection may be unnecessary in lower lobe tumors with no metastasis to hilar, subcarinal, and lower mediastinal nodes on frozen sections according to the preoperative T status
Of the 207 patients with NSCLC of less than 5 cm with N2 involvement, 55 (27 %) had skip metastasis, and 97 (47 %) had both hilar and the remaining 55 patients had metastatic segmental lymph nodes or subsegmenta lymph nodes with mediastinal lymph nodes metastasis

Summary

Introduction

Lobectomy with systematic mediastinal lymph node dissection (LND) has been considered the standard of care for resectable non-small cell lung cancer (NSCLC). Selective lymph node dissection (SLND) based on the tumor location-specific lymphatic pathway should be undertaken especially for patients with no apparent lymph node metastasis or with impaired pulmonary function, or for elderly patients. We retrospectively reviewed the prevalence of lymph node involvement in each mediastinal region in. The purpose of the present study was to determine the nodal spread patterns of pN2 non-small cell lung cancer (NSCLC) according to tumor location, and to attempt to evaluate the possible indications of selective lymph node dissection (SLND). Methods We retrospectively analyzed nodal spread patterns in 207 patients with NSCLC of less than 5 cm with N2 involvement

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