M. Zieliński1, J. Kużdzal1, L. Hauer1, J Pankowski2, T. Nabialek3, A. Szlubowski3, W. Sośnicki1, J. Hauer1.
1Intensive Care Medicine of Pulmonary Hospital-Department of Thoracic Surgery, Zakopane, Poland, 2Intensive Care Medicine of Pulmonary Hospital-Department of Pathology, Zakopane, Poland, 3Intensive Care Medicine of Pulmonary Hospital-Department of Anesthesiology, Zakopane, Poland.
OBJECTIVE:
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)
METHODS:
421 patients with NSCLC were operated on from 1.1.2004 to 30.9.2007. 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). Patient’s age, sex, histology and localization of the tumor, duration of operation, intraoperative and postoperative complications, numbers and localizations of the normal and metastatic nodes were recorded.
RESULTS:
There were 421 patients, 359 men and women in age 41-81 (mean age 61.6). There were 287 squamous-cell carcinomas, 80 adenocarcinomas and 54 others. Time of operation was 60 to 330 min (mean 148.8 min). There were 5 postoperative deaths unrelated to the procedure (mortality 1.2%). Complications of TEMLA occurred in 37/421 patients (8.8%) with temporary laryngeal nerve palsy in 11/421 patients (2.6%) and 2 permanent nerve palsy (0.5%).
The number of dissected nodes during TEMLA was 15 to 85 (mean 38.1). N2 nodes were found in 111 patients (26.4%) and N3 nodes in 15 patients (3.6%). In most of N2 cases there was one-station involvement (max. - 4 stations) and the type of tumor was squamous cell carcinoma. In N3 cases there was at least two-station involvement (max. - 9 stations) and adenocarcinoma predominated. After negative result of TEMLA 251/ 295 patients underwent subsequent thoracotomy. There were 239 pulmonary resections and 12 explorations (4.7%). During thoracotomy, omitted N2 was found in 7/251 patients (3.9%) and omitted normal mediastinal nodes were found in 17/251 patients (6.8%). Postoperative mortality after pulmonary resection was 5/239 (2.1%). Diagnostic yield of TEMLA in discovery of N2-3 nodes: sensitivity 94.7 %, specificity 100%, Negative Predictive Value (NPV) 97.6 %, Positive Predictive Value (PPV) 100% and accuracy 98.3%.
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
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