Systematic Node Dissection Research Articles

Bronchial carcinoma: metastatic pathways with involvement of hilar and mediastinal lymph nodes

Lung cancer has enormous socioeconomical impact on our society due to its high prevalence and mortality. About 59,700 new cases of lung cancer were forecasted for 2022. Correct staging is the basis for therapy planning, prognosis estimation, and future analyses. Staging is performed using the TNM scheme from the Union for International Cancer Control (UICC). Involvement of lymph nodes is used to differentiate between stage IIB and IIIC. Knowledge of the intrathoracic lymph node levels is crucial for the exact classification and its involvement has direct implications on therapy. The International Association for the Study of Lung Cancer (IASLC) proposed aunified lymph node map with exact anatomic definitions, which is recommended by the German national lung cancer guideline. The extent of lymph node involvement is stratified into N0-N3. Different metastatic paths are known depending on the location of the primary tumor, but the burden of disease has agreater influence on survival, than the location of metastases. Computed tomography can assess operability of the primary tumor safely in most cases. Invasive procedures to confirm the diagnosis by sampling tissue should be performed after noninvasive diagnostics. Systematic lymph node dissection for all patients with non-small cell lung cancer intended for curative resection is recommended in the current German national guideline for lung cancer.

Is advanced bipolar v anced bipolar vessel sealing de essel sealing device really eff eally effective in decreasing the pelvic lymphocele ratio in open surgery for endometrial cancer?

We aim to show pelvic lymphocele (PL) rates in patients who were operated for endometrial cancer (EC) and underwent systematic paraaortic bilateral pelvic lymph node dissection (PABPLND) with advanced bipolar vessel sealing device (ABVSD). The medical files of all patients who underwent open surgery for EC between January 2017 and December 2021 were retrospectively analyzed. One hundred three patients who operated with the diagnosis of high-intermediate and high-risk endometrial cancer were included. Systematic PABPLND was performed with total abdominal hysterectomy with or without bilateral salpingo-oophorectomy during surgery to all patients. All operations were performed by same three surgeons who were expert in their field. While the lymph packages were removed during surgical dissection, the distal afferent and proximal efferent lymphatic channels were sealed with LigaSure™ blunt tip sealer/divider (Medtronic, Covidien, USA). The patients were scanned with computed tomography (CT) between 8 and 12 weeks postoperatively. Lymphocele diagnosis was confirmed by radiologists and largest diameter was recorded. Clinical-pathological findings of all patients were recorded. Mean age and body mass index (BMI) of all participants were 58.6 ±10.2 years and 28.1± 5.6 kg/m2 . The most histopathological findings were endometrioid type (84.5%) and grade 2 (44.2%) ECs. The pelvic lymphocele (PL) was detected with CT in 24 of 103 patients at 8 to 12 weeks postoperatively. Only two PL patients were symptomatic. The first patient had symptoms of pelvic fullness and compression while the second patient had infected image. PL was located to right pelvic area in first case while the second was located on the vaginal cuff. The dissection and sealing of major lymph vessels were achieved during the removal of all lymph packages with LigaSure™ blunt tip laparoscopic sealer/divider. The use of advanced bipolar systems can reduce the formation of PL in lymph node dissection in endometrial cancer.

Role of systematic lymphadenectomy in patients with intermediate to high-risk early stage endometrial cancer.

To determine the clinical significance of systematic lymph node dissection (LND) and to better define the relevant extent of LND in intermediate- to high-risk early stage endometrial cancer (EC). Patients who received surgery as a primary treatment of histologically confirmed EC and preoperatively considered as uterus-confined early stage disease were included in the study population. The rates of lymph node metastasis (LNM) according to the risk groups and anatomic sites were assessed. Univariate and multivariate analyses were performed to evaluate risk factors for recurrence. A total of 804 patients were included in the study analysis. The rates of LNM were significantly different according to the risk group; 1.2% in low-risk, 20.1% in intermediate-risk, and 30.0% in high-risk group. When assessing the rates of LNM in individual anatomic sites, positive LNs were evenly distributed throughout the pelvic and para-aortic regions. In the intermediate to high-risk EC cases, the rates of para-aortic LNM below and above inferior mesenteric artery (IMA) were 11.1% and 12.5%, respectively. On multivariate analysis, LNM was the only independent risk factor for recurrence in the intermediate to high-risk EC (hazard ratio=2.63, 95% confidence interval=1.01-6.82, p=0.047). LNM was frequently observed in intermediate- and high-risk early stage EC and it served as an independent risk factor for recurrence. When considering the similar rates of LNM between below and above IMA, nodal assessment needs to be performed up to the infra-renal level, especially for the staging purpose in high-risk EC.

Impact of bilateral mediastinal lymph node dissection on pulmonary function during the early postoperative period after curative-intent lung surgery for cancer: a randomized study.

Bilateral lymph node dissection is not a standard surgical treatment for non-small cell lung carcinoma. However, data from anatomical studies showing lymph flow to the contralateral mediastinal lymph nodes have prompted attempts to extend lymph node dissection to the contralateral mediastinum. Little is known about the functional effects of extended lymphadenectomy. This study aimed to determine whether bilateral mediastinal lymphadenectomy (BML) performed as part of lung cancer surgery leads to more severe impairment of respiratory function than standard systematic lymph node dissection (SLND). Respiratory function data were derived from a randomized clinical study (BML-1), which included patients with non-small cell lung cancer (NSCLC) who underwent curative-intent lung resection with standard SLND or BML. Lung function tests were performed preoperatively and on postoperative days 1, 3-5, 7-9, and 30-32. Data from 89 patients were available for the final analysis of the BML-1 study: 40 and 49 underwent BML and SLND, respectively. Complete respiratory function test data were available for 35 patients. The age, sex, Thoracoscore, revised cardiac risk index, dyspnea score, lobar location of the tumor, histology, preoperative pulmonary function test results, and type of lung resection were comparable for both groups. The vital capacities (VCs) were not different on postoperative days 1, 3-5, 7-9, and 30-32 (P=0.49, 0.66, 0.18, and 0.16, respectively). The forced expiratory volumes in 1st second (FEV1) obtained at the same time points were not different (P=0.40, 0.72, 0.81, and 0.32, respectively). BML was not associated with a more severe deterioration of respiratory function than standard (unilateral) lymph node dissection.

Reasoning about Ilo-Mediastinal Lymphectomy during Lung Metastasectomy for Colorectal Cancer: Appropriate or Unnecessary Effort?

Lymph node dissection following lung metastasectomy is still debated, although it is considered necessary to achieve complete resection or at least gather prognostic information. When radical lymph node dissection is performed, the average rate of unexpected lymph node involvement in colorectal cancer is less than 20%. Lymph node co-involvement is an adverse prognostic factor, and preoperative mediastinal disease usually leads to patient exclusion from metastatic surgery. The authentic prognostic influence of systematic nodal dissection remains unclear. Unfortunately, many studies demonstrate no positive effect of lymphadenectomy during lung metastasectomy other than a pseudo-stage migration effect. Future studies should focus not only on survival but also on local and lymph node recurrence.

Clinical Outcomes after Upfront Surgery in Clinical Stage I-IIA Small Cell Lung Cancer.

Upfront surgery followed by systemic treatment is recommended to treat clinical stage I-IIA small cell lung cancer (SCLC), but data on the clinical outcomes are sparse. Thus, this study evaluated the stage migration and long-term prognosis of surgically treated clinical stage I-IIA SCLC. We retrospectively reviewed 49 patients with clinical stage I-IIA SCLC who underwent upfront surgery between 2000 and 2020. Additionally, we re-evaluated the TNM (tumor-node-metastasis) staging according to the eighth edition of the American Joint Committee on Cancer staging system for lung cancer. The clinical stages of SCLC were cIA in 75.5%, cIB in 18.4%, and cIIA in 6.1% of patients. A preoperative histologic diagnosis was made in 65.3% of patients. Lobectomy and systematic lymph node dissection were performed in 77.6% and 83.7% of patients, respectively. The pathological stages were pI in 67.3%, pII in 24.5%, pIII in 4.1%, and pIV in 4.1% of patients. The concordance rate between clinical and pathological stages was 44.9%, and the upstaging rate was 49.0%. The 5-year overall survival (OS) rate was 67.8%. No significant difference in OS was found between stages pI and pII. However, the OS for stages pIII/IV was significantly worse than for stages pI/II (p<0.001). In clinical stage I-IIA SCLC, approximately half of the patients were pathologically upstaged, and OS was favorable after upfront surgery, particularly in pI/II patients. The poor prognosis of pIII/IV patients indicates the necessity of intensive preoperative pathologic mediastinal staging.

Long-term results of postoperative unsuspected small cell lung cancer on real-world data

BackgroundIn traditional opinion, solid pulmonary nodule suspected lung cancer should be confirmed by pathology before the operation to exclude small cell lung cancer (SCLC), considering SCLC tends to be aggressive and surgical effect in the management of SCLC remains controversial. The aim of this study was to evaluate the survival result and risk factors of postoperative unsuspected SCLC.MethodsA total of 120 patients with postoperative unsuspected SCLC who were confirmed by pathology and referred to Chinese PLA General Hospital between 2000 and 2021 were retrospectively analyzed (surgery group). Additionally, 120 patients with limited-stage SCLC who underwent chemotherapy and radiotherapy in the same period were enrolled in the chemoradiotherapy group.. Kaplan–Meier method was used to estimate survival; the Log-Rank test was used to compare survival rates between different groups; a COX stepwise regression model was used for multivariate analysis.ResultsAmong 120 patients in the surgery group, 28 were with central type and other 92 with peripheral type. The median survival (OS) was 44.85 months, and the 5-year survival rate was 46%. The 5-year survival rates for stage I, II, and III were 52.1%, 45.4%, and 27.8%, respectively. The mean disease-free survival time (DFS) was 30.63 ± 4.38 months, and the 5-year DFS rate was 31.5%. In the chemoradiotherapy group, the mean OS was 21.4 ± 4.26 months, and the 5-year survival rate was 28.3%. The 5-year survival rates for clinical stage I, II, and III were 42.5%, 39.8%, and 20.5%, respectively. The mean progression-free survival (PFS) was 10.63 ± 3.6 months. In the surgery group, one-way ANOVA revealed that the gender, symptoms, smoking history, tumor location, and postoperative radiotherapy were not associated with OS (P ≥ 0.05), while age, surgical approach, surgical method, N stage, TNM stage, and vascular tumor thrombus were related to OS (P < 0.05). Multivariate analysis indicated that the N stage was associated with OS (HR = 1.86 P = 0.042).ConclusionSurgery and adjuvant therapy were found to have encouraging outcomes in postoperative unsuspected SCLC. Patients with stage I, stage II and part of stage IIIA SCLC could benefit from surgery and the standard lobectomy, and systematic lymph node dissection, is also recommended for these patients.

Surgical technique of axillary, inguinal and iliac lymph node dissection

Systematic lymph node dissection (SLND) plays an important role in the surgical treatment of many tumors. Despite continuous developments in surgical techniques, the morbidity in axillary, inguinal and iliac SLND remains high. Description of the currently existing surgical techniques of axillary, inguinal and iliac SLND with presentation of the possible advantages and disadvantages, also with respect to the oncological results. Based on the currently available literature reports, study results and own experience, the techniques of SLND and treatment results are presented. SLND in the axillary, inguinal and iliac regions is still achallenging procedure for surgeons and patients. This problem exists due to the complex anatomy and the high morbidity. Modifications of open surgical techniques led to areduction of postoperative complications only in rare exceptions. Minimally invasive iliac SLND is possible and can be performed both by laparoscopy and retroperitoneoscopy. The application of videoscopic techniques in axillary and inguinal SLND is also possible and the feasibility has been confirmed in different studies. Using minimally invasive approaches asignificant reduction in wound complications could be achieved. Nevertheless, up to now the oncological results of minimally invasive surgery are still unclear, especially for malignant melanoma. By using minimally invasive SLND in the axillary, inguinal and iliac regions, asignificant reduction of wound complications can be achieved. Further prospective studies are needed to confirm the initially promising results, especially with respect to the oncological outcome.

Intraoperative ultrasound: "Alternative eye" in lymph nodal dissection in non-small cell lung cancer.

Staging of the mediastinum lymph nodes involvement in patients with non-small cell lung cancer (NSCLC) is an important prognostic factor determining the most appropriate multimodality treatment plan. The objective of this study is to assess ultrasound characteristics of mediastinal lymph nodes metastasis and effectiveness of intraoperative ultrasound-guided mediastinal nodal dissection in patients with resected NSCLC. All patients undergoing video-assisted thoracoscopic surgery lobectomy and pulmonary lymphadenectomy from November 2020 to March 2022 at the thoracic surgery department of the Vanvitelli University of Naples underwent intraoperative ultrasound-guided mediastinal lymph nodal dissection. This study evaluates whether individual B-mode features and a compounding thereof can be used to accurately and reproducibly predict lymph node malignancy. Intraoperative ultrasound, during systematic mediastinal lymph node dissection, is helpful in preventing lesion to mediastinal structures. Pathological nodal sonographic characteristics are round shape, short-axis diameter, echogenicity, margin, the absence or presence of coagulation necrosis sign, and the absence or presence of central hilar structure, increased color Doppler flow, the absence or presence of calcification, and nodal conglomeration. Operating time was not substantially prolonged. The procedure is simple, safe and highly accurate. Ultrasonic techniques allow surgeons to detect the relationship between lymph nodes and surrounding large blood vessels during biopsy, improving the safety and simplicity of the operation, increasing the number of harvested lymph nodes, and reducing the risk of intraoperative injury; it is a fast, easily reproducible, and inexpensive method.

Visualization of patterns of lymph node metastases in non–small cell lung cancer using network analysis

ObjectiveWe aimed to visualize complicated patterns of lymph node metastases in surgically resected non–small cell lung cancer by applying a data mining technique. MethodsIn this retrospective study, 783 patients underwent lobectomy or pneumonectomy with systematic mediastinal lymph node dissection for non–small cell lung cancer between January 2010 and December 2018. Surgically resected lymph nodes were classified according to the International Association for the Study of Lung Cancer lymph node map. Network analysis generated patterns of lymph node metastases from stations 1 to 14, and the degree of connection between 2 lymph node stations was assessed. ResultsThe median number of lymph nodes examined per patient was 20, and the pathological N category was pN0 in 428 cases, pN1 in 132, pN2 in 221, and pN3 in 2. N1 lymph node stations had strong associations with superior mediastinal lymph node stations for patients with primary tumors in the upper lobes and with station 7 for the lower lobes. There was also a connection from the N1 lymph node stations to superior mediastinal lymph node stations in the lower lobes. In the right middle lobe, an even distribution from station 12m toward stations 2R, 4R, and 7 was noted. We released an interactive web application to visualize these data: http://www.canexapp.com. ConclusionsLymph node metastasis patterns differed according to the lobe bearing the tumor. Our results support the need for clinical trials to further investigate selective mediastinal lymph node dissection.

Prise en charge chirurgicale des cancers bronchiques non à petites cellules de stade localisé : voie d’abord et étendue de la résection

Surgical resection is the cornerstone of the management of operable patients with stage I and II non-small-cell lung cancer. Surgical approaches have evolved from open thoracotomy to mini-invasive surgery, including video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS), with a clear benefit in terms of postoperative pain, respiratory complications, and hospital length of stay. Surgical resection should include anatomic resection of the parenchyma and systematic lymph node dissection. For stage I and II disease, and operable patients, lobectomy remains the most widely used procedure. In the subset of patients with stage I tumors measuring less than 2 cm, segmentectomy is acceptable for patients with compromised lung function, multiple tumors, and in ground-glass predominant lesions. Recent trials suggest that segmentectomy might also be acceptable for patients with solid predominant stage I tumors measuring less than 2 cm, but confirmatory trial is pending, and guidelines have not evolved yet.1877-1203/© 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Does the character of the hospital of primary management influence outcomes in patients treated for presumed early stage endometrial cancer and atypical endometrial hyperplasia: a comparison of outcomes from a cancer unit and cancer centre

A retrospective study from 2015 to 2020 comparing overall survival (OS) outcomes of a cancer unit and centre for presumed early stage endometrial cancers is presented. Cancer centres manage these presumed early endometrial cancer (EC) in situations of complex co-morbidities, surgical challenges as well as their own local unit patients. Our analysis compares 138 patients at KMH (unit) and 282 patients at RDH (centre) on OS, patient demographics, grading histology and final histology. Patients with presumed early stage EC can be reassured regarding no difference in OS between the cancer unit and centre management (p = .05). However, rates of minimal access surgery were higher at the cancer centre compared to the unit (93.2% versus 68.1%). The rates of upstaged disease were 4% and 8.8% at the cancer unit and centre respectively (p = .096). Sentinel node biopsy and genomic assessment may change future thresholds for centre-level management due to rates of upstaged disease. Impact Statement What is already known on this subject? Presumed lower risk endometrial cancers (endometrioid grades 1 and 2) have a rate of occult nodal involvement of only 1.4%. The BGCS does not recommend lymphadenectomy for low-risk endometrial cancers. These low-risk endometrial cancers should be managed with a hysterectomy and bilateral salpingo-ophrectomy via minimal access surgery. In view of the low rates of occult nodal involvement in low-risk endometrial cancer, surgery can be offered at a cancer unit. What do the results of this study add? Our study demonstrates there is no disadvantage in overall survival in the surgical management of presumed low-risk endometrial cancers at cancer units and centres. However, cancer centres have higher rates of minimal access to surgery despite managing a more elderly population. Our rates of upstaged disease of 4% and 8.8% at the cancer unit and centre indicate a potential benefit of pelvic lymph node assessment. What are the implications of these findings for clinical practice and/or further research? Sentinel lymph node biopsy does not have the surgical morbidity associated with systematic lymph node dissection. Therefore, when applied to presumed early stage endometrial cancer, there are potential changes in the threshold for centre-level management to improve overall survival.

Thoracic follicular dendritic cell sarcoma - an outlandish presentation of a rare tumour with review of literature.

Follicular dendritic cell sarcoma is a rare low grade malignant neoplasm that arises from follicular dendritic cells in lymphoid tissue germinal centres and accounts for 0.4% of all soft tissue sarcomas. It is extremely rare to have pulmonary follicular dendritic cell sarcoma with endobronchial extension and as an anterior mediastinal mass with mediastinal lymph node involvement. We present the case of a 34-year-old male non-smoker who had been experiencing chest pain for three months. A lobulated left peri-hilar mass with endobronchial spread into the left main bronchus and mediastinal lymphadenopathy was identified on a chest CT. The bronchoscope-guided cryobiopsy of the endobronchial mass was inconclusive. After a thorough multidisciplinary discussion, the patient underwent left sided pneumonectomy, mediastinal mass resection, and systematic lymph node dissection. Histologic examination using immunohistochemistry revealed follicular dendritic cell sarcoma.

Impact of lymph node staging in presumed early-stage ovarian carcinoma

ObjectiveOur objective was to analyze the prevalence of lymph node metastasis in early-stage ovarian carcinoma after systematic lymph node dissection and its impact on indication of adjuvant chemotherapy. Study designWe evaluated a series of 765 patients diagnosed with ovarian carcinoma who underwent surgical treatment from February 2007 to December 2019. Patients with peritoneal disease and incomplete surgical staging were excluded. All cases underwent systematic pelvic and para-aortic lymphadenectomy up to the renal vessels. ResultsA total of 142 cases were analyzed. Median pelvic and para-aortic lymph node dissected were 30 (range, 6–81) and 21 (range, 3–86), respectively. Twelve (8.4%) patients had metastatic lymph nodes – high-grade serous, 10.4% (5/48); clear cell, 17.2% (5/29) and endometrioid, 5.7% (2/35). Any other histology (low grade serous, mucinous, carcinosarcoma or mixed) had lymph node metastasis. Notably, 50% of patients with positive lymph nodes had preoperative suspicious lymph nodes in imaging. The median hospital stay length was 6 days (range, 2–33) and 4.2% cases had grade ≥ 3 complications. A total of 110 (77.6%) patients underwent adjuvant chemotherapy and all cases had indication of adjuvant chemotherapy after histological type, despite the lymph node status. After a median follow-up of 52.5 months, we noted 24 (16.9%) recurrences. The 5-year recurrence-free survival and overall survival were 86.4% and 98.1%, respectively. High grade histology was the only variable that negatively impacted disease-free survival in univariate analysis [HR 4.70 (95%CI: 1.09–20); p = 0.037]. ConclusionsWe found a positive lymph node rate of less than 10% after lymphadenectomy in presumed early-stage ovarian carcinoma. Lymph node status was not determinant for adjuvant chemotherapy.

Sentinel lymph node detection in early stage ovarian cancer: the primary experience in N. N. Blokhin national medical Research Center of Oncology

Background. Surgical staging including pelvic and para-aortic lymphadenectomy is recommended in patients with clinical early-stage epithelial ovarian cancer. The therapeutic role of pelvic and para-aortic lymphadenectomy is still under debate, this procedure can increase risk of intra- and post-operative complications. using the sentinel lymph node (SLN) detection in early stage ovarian cancer in very promising and decreases the level of surgical damage. But nowadays the data on effectiveness, safety sensitivity and specificity of SLN are limited and the technique has to be standardized.Aim. To determine the feasibility of the SLN detection procedure using indocyanine green in early stage ovarian cancer.Materials and methods. four patients with clinical stage I epithelial ovarian cancer underwent SLN detection using indocyanine green. The tracer was injected into hilum of the ovary or ovarian ligament stumps in the case of previous adnexectomy. SLN were detected in infrared spectrum. Systemic retroperitoneal lymph node dissection of the pelvic and paraaortic areas was performed after SLN being removed. frozen section of was not performed in this study.Results. SLN were detected in paraaortic area in three of four patients. no one of patients had metastatic disease.Conclusion. The primary experience demonstrates SLN mapping of the ovary being feasible. Prospective study is required to evaluate sensitivity and specificity of SLn detection in early stage ovarian cancer.

The comparison of Lobe-Specific or Systematic Mediastinal Lymph Node Dissection for Early-Stage Lung Adenocarcinoma With Consolidation Tumor Ratio Over 0.5

IntroductionSurgery is the most effective treatment for early-stage lung cancer. This study will propose a personalized plan for mediastinal lymph node dissection in early-stage lung adenocarcinoma to reduce the risk of surgery and improve the quality of life. MethodsThis study retrospectively analyzed the patients underwent lobectomy and lymph node dissection in the Department of Thoracic Surgery, Zhongshan Hospital, Fudan University. Clinical stage I lung adenocarcinoma patients with solid component ratio (CTR) between 0.5 and 1 were included. Patients were divided into systematic (S-MLND) and lobe-specific (L-MLND) mediastinal lymph node dissection groups. The days of hospitalization, the presence or absence of complications, the recurrence-free survival rate, and the overall survival rate were calculated to evaluate the postoperative quality and operation risk of the patients. Results210 patients (138 L-MLND and 72 S-MLND) were included. 2 lymph node metastases appeared in the S-MLND group while none in the L-MLND group (P = .049). No differences were shown in age, tumor site, size, solid component, degree of tumor invasion, and stage. The proportion of patients with severe postoperative cough and the length of hospital stay in the L-MLND group decreased. The 5-year OS of the entire cohort was 98.1%, 98.6% in L-MLND, compared with 97.2% in S-MLND; RFS was 94.8%, 95.7% in L-MLND, compared with 93.0% in S-MLND. ConclusionFor cIA lung adenocarcinoma, according to the Thin-slice CT within 1 month before the operation, if the main lesion was less than 3 cm and CTR over 0.5, L-MLND is as effective as S-MLND.

A predictive nomogram for lymph node metastasis in part-solid invasive lung adenocarcinoma: A complement to the IASLC novel grading system.

BackgroundThe International Association for the Study of Lung Cancer (IASLC) proposed a novel grading system for invasive lung adenocarcinoma, but lymphatic invasion was not evaluated. Meanwhile, the scope of lymph node dissection in part-solid invasive lung adenocarcinoma (PSILA) is still controversial. Therefore, this study aims to explore preoperative risk factors for lymph node metastasis in PSILA, to provide reference for intraoperative dissection of lymph nodes.MethodsFrom 2018 to 2020, clinical data of patients (stage cN0) consecutively diagnosed as PSILA were retrospectively analyzed and classified according to the novel grading system. Logistic regression was conducted to screen the clinicopathological factors of lymph node metastasis in PSILA.ResultsA large cohort of 960 patients with PSILA who underwent lobectomy or sub-lobectomy were enrolled. By logistic regression analyses, solid part size, bronchial cutoff sign, spiculation, and carbohydrate antigen 199 (CA199) were eventually identified as independent risk factors for lymph node metastasis, based on which a nomogram was built to preoperatively predict the risk of lymph node metastasis [area under the receiver operating characteristic curve (AUC)=0.858; concordance index = 0.857; best cutoff, 0.027]. This suggests that intraoperative systematic lymph node dissection is recommended when the predicted risk value exceeds 0.027. Reproducibility of the novel grading system was verified.ConclusionsThe novel IASLC grading system was applicative in real world. The nomogram for preoperative prediction of lymph node metastasis may provide reference for the lymph node dissection strategy during PSILA surgeries.

The prognostic influence of histological subtypes of micropapillary tumors on patients with lung adenocarcinoma ≤ 2 cm.

ObjectiveThis study aimed to explore the value of micropapillary histological subtypes in predicting the specific surgical specificity and lymph node metastasis prognosis of early lung adenocarcinoma.MethodsA total of 390 patients with lung adenocarcinoma were included who underwent surgery in the Department of Thoracic Surgery of the Affiliated Provincial Hospital of Anhui Medical University from January 2016 to December 2017. The data were analysed with SPSS 26.0 statistical software, and the clinicopathological data of the two groups were compared with the chi-square test. The survival rate was calculated by the Kaplan-Meier method, and the difference in survival rate between groups was analysed by the log-rank test. Multivariate survival analysis was performed using the Cox model.ResultsUnivariate analysis of the clinicopathological data of the patients showed that the micropapillary histological subtype was significantly associated with the survival rate of patients (p=0.007). The clinicopathological data of the patients were substituted into the Cox model for multivariate analysis, and the results showed that the micropapillary histological subtype was an independent prognostic factor affecting the survival rate of the patients (p=0.009).The average survival time of Group A (micronipple composition > 5%) was 66.7 months; the 1-year, 3-year, and 5-year survival rates were 98.8%, 93.0%, and 80.9%, respectively.The survival of the lobectomy group was better than that of the sublobectomy group and the survival of patients with systematic dissection was better than that of patients with limited lymph node dissection. The average survival time of Group B (micronipple composition ≤ 5%) was 70.5 months; the 1-year, 3-year, and 5-year survival rates were 99.3%, 95.4%, and 90.6%, respectively. There was no difference in the survival rate between the lobectomy group and sublobectomy group, and there was also no difference in survival between systematic lymph node dissection and limited lymph node dissection, The survival rate of Group B was significantly better than that of Group A.ConclusionThe micropapillary histological component is an independent risk factor after surgery in patients with ≤2 cm lung adenocarcinoma. When the proportion of micropapillary components is different, the prognosis of patients is different when different surgical methods and lymph node dissections are performed. Lobectomy and systematic lymph node dissection are recommended for patients with a micropapillary histological composition >5%; sublobar resection and limited lymph node dissection are recommended for patients with a micropapillary histological composition ≤5%.

Fluorescence-guided Lymph Vessel Sealing in Systematic Nodal Dissection: a New Surgical Technique to Prevent Lymphorrhea and Lymphocele.

The primary morbidities of inguinal and axillary systematic nodal dissection are lymphatic fistulas and seromas. Intraoperative fluorescence imaging-guided sealing of lymph vessels may prevent these postoperative complications. Indocyanine dye was injected intracutaneously into the distal limb before the beginning of the lymphadenectomy. Systematic nodal dissection was performed according to standard protocols. Near-infrared imaging was applied throughout the procedure and real-time fluorescence-guided lymph vessel sealing was performed. Fluorescence-guided lymph vessel sealing was implemented in three patients undergoing axillary systematic lymph node dissection. No adverse events occurred following fluorescence dye injection. All patients could be discharged free of wound complications. Fluorescence-guided lymph vessel sealing might be a promising new technique for preventing lymphatic fistulas and lymphocele after systematic lymphadenectomy.

LobE-Specific lymph node diSsectiON for clinical early-stage non-small cell lung cancer: protocol for a randomised controlled trial (the LESSON trial)

IntroductionLung cancer was the most common malignancy and the leading cause of cancer-related death in China or worldwide, and surgery is still the preferred treatment for early-stage non-small cell lung...