Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) for Staging of Non-Small-Cell Lung Cancer (NSCLC)

Abstract

Introduction: The aim of the study is to analyze diagnostic yield of the new surgical technique — the Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) in preoperative staging of Non-Small-Cell Lung Cancer (NSCLC). Material and methods: Operative technique included 5–8 cm collar incision in the neck, elevation of the sternal manubrium with a special retractor, bilateral visualization of the laryngeal recurrent and vagus nerves and dissection of all mediastinal nodal stations except of the pulmonary ligament nodes (station 9). Results: 698 patients (577 men, 121 women), of mean age 62.8 (41–79) were operated on from 1.1.2004 to 31.1.2010, including 501 squamous-cell carcinomas, 144 adenocarcinomas, 25 large cell carcinomas and 28 others. Mean operative time was 128 min. (45 to 330 min.) and 106.5 min. in the last 100 patients. 30-day mortality was 0.7% (unrelated causes) and morbidity 6.6%. The mean number of dissected nodes during TEMLA was 37.9 (15 to 85). Metastatic N2 and N3 nodes were found in 152/698 (21.8%) and 26/698 patients (3.7%), respectively. Subsequent thoracotomy was performed in 445/ 513 patients (86.7%) after negative result of TEMLA. During thoracotomy, omitted N2 was found in 7/445 (1.6%) patients. Sensitivity of TEMLA in discovery of N2–3 nodes was 96.2%, specificity was 100%, accuracy was 99,0%, Negative Predictive Value (NPV) was 98.7% and Positive Predictive Value (PPV) was 100%. Conclusions: TEMLA is a new minimally invasive surgical procedure providing unique possibility to perform very extensive, bilateral mediastinal lymphadenectomy with very high diagnostic yield in staging of NSCLC.