中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

根治性肺癌切除术中淋巴结切除的质量控制

查看全文

淋巴结清扫是肺癌根治标准手术中必不可少的环节。淋巴结清扫质量决定了手术完整切除的程度及淋巴结分期的准确性。第 8 版肺癌 TNM 分期对淋巴结分期给出了明确的定义。由此,我们建议根据该分期对术中清扫淋巴结进行标记。系统性淋巴结清扫仍是淋巴结切除的金标准,应至少切除纵隔 3 站共不少于 12 个淋巴结,并尽量行整块切除。对于临床Ⅰ期肺癌、胸腔镜及机器人辅助腔镜下淋巴结清扫的肿瘤学预后与开放手术无显著性差异。在特定的早期患者中行选择性的有限淋巴结清扫还需要进一步临床证据验证。

As a standard of care, lymph node dissection is an indispensible step in lung cancer surgery. The quality of dissection determines completeness of surgery and the accuracy of N staging. Hereby, we suggest labeling all surgically resected nodes according to the new lymph node map in the 8th TNM classification for lung cancer. As systematic lymph node dissection remains the gold standard of lymphadenectomy, at least three mediastinal stations and twelve nodes should be removed in an en-bloc fashion, if possible. For patients with stage Ⅰ lung cancer, lymph node dissection via video assisted thoracoscopic surgery (VATS) or open thoracotomy may has similar oncological outcome. Besides, limited lymph node sampling in selected patients with early staged lung cancer to minimize unnecessary surgical damage still need further investigation.

关键词:  ;  ;  

Key words: Lung cancer; lymph node dissection; quality control

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
2. Cahan WG. Radical lobectomy. J Thorac Cardiovasc Surg, 1960, 39: 555-572.
3. Martini N, Flehinger BJ, Zaman MB, et al. Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases. Ann Surg, 1983, 198(3): 386-397.
4. Naruke T, Goya T, Tsuchiya R, et al. The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node metastasis. Ann Thorac Surg, 1988, 46(6): 603-610.
5. Mountain CF. Revisions in the international system for staging lung cancer. Chest, 1997, 111(6): 1710-1717.
6. Rami-Porta R, Wittekind C, Goldstraw P, et al. Complete resection in lung cancer surgery: proposed definition. Lung Cancer, 2005, 49(1): 25-33.
7. Smeltzer MP, Faris NR, Ray MA, et al. Association of Pathologic Nodal Staging Quality with survival among patients with non-small cell lung cancer after resection with curative intent. JAMA Oncol, 2018, 4(1): 80-87.
8. Darling GE, Maziak DE, Inculet RI, et al. Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: results of mediastinal staging in the early lung positron emission tomography trial. J Thorac Oncol, 2011, 6(8): 1367-1372.
9. D'Cunha J, Herndon JE 2nd, Herzan DL, et al. Poor correspondence between clinical and pathologic staging in stage 1 non-small cell lung cancer: results from CALGB 9761, a prospective trial. Lung Cancer, 2005, 48(2): 241-246.
10. Darling GE. Current status of mediastinal lymph node dissection versus sampling in non-small cell lung cancer. Thorac Surg Clin, 2013, 23(3): 349-356.
11. Früh M, Rolland E, Pignon JP, et al. Pooled analysis of the effect of age on adjuvant cisplatin-based chemotherapy for completely resected non-small-cell lung cancer. J Clin Oncol, 2008, 26(21): 3573-3581.
12. Asamura H, Chansky K, Crowley J, et al. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revision of the N Descriptors in the Forthcoming 8th Edition of the TNM Classification for Lung Cancer. J Thorac Oncol, 2015, 10(12): 1675-1684.
13. Nohl-Oser HC. An investigation of the anatomy of the lymphatic drainage of the lungs as shown by the lymphatic spread of bronchial carcinoma. Ann R Coll Surg Engl, 1972, 51(3): 157-176.
14. Lardinois D, Brack T, Gaspert A, et al. Bronchoscopic radioisotope injection for sentinel lymph-node mapping in potentially resectable non-small-cell lung cancer. Eur J Cardiothorac Surg, 2003, 23(5): 824-827.
15. Riquet M, Hidden G, Debesse B. Direct lymphatic drainage of lung segments to the mediastinal nodes. An anatomic study on 260 adults. J Thorac Cardiovasc Surg, 1989, 97(4): 623-632.
16. Prenzel KL, Mönig SP, Sinning JM, et al. Role of skip metastasis to mediastinal lymph nodes in non-small cell lung cancer. J Surg Oncol, 2003, 82(4): 256-260.
17. Kim AW. Lymph node drainage patterns and micrometastasis in lung cancer. Semin Thorac Cardiovasc Surg, 2009, 21(4): 298-308.
18. Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg, 1978, 76(6): 832-839.
19. Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg, 2006, 30(5): 787-792.
20. Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1(less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg, 2011, 141(3): 662-670.
21. Deslauriers J. Mediastinal lymph nodes: ignore? sample? dissect? The role of mediastinal node dissection in the surgical management of primary lung cancer. Gen Thorac Cardiovasc Surg, 2012, 60(11): 724-734.
22. Watanabe S, Asamura H. Lymph node dissection for lung cancer: significance, strategy, and technique. J Thorac Oncol, 2009, 4(5): 652-657.
23. Adachi H, Sakamaki K, Nishii T, et al. Lobe-specific lymph node dissection as a standard procedure in surgery for non-small cell lung cancer: a propensity score matching study. J Thorac Oncol, 2017, 12(1): 85-93.
24. Hishida T, Miyaoka E, Yokoi K, et al. Lobe-specific nodal dissection for clinical stage i and ii nsclc: japanese multi-institutional retrospective study using a propensity score analysis. J Thorac Oncol, 2016, 11(9): 1529-1537.
25. David EA, Cooke DT, Chen Y, et al. Does lymph node count influence survival in surgically resected non-small cell lung cancer? Ann Thorac Surg, 2017, 103(1): 226-235.
26. Liang W, He J, Shen Y, et al. Impact of examined lymph node count on precise staging and long-term survival of resected non-small-cell lung cancer: a population study of the us seer database and a chinese multi-institutional registry. J Clin Oncol, 2017, 35(11): 1162-1170.
27. Gajra A, Newman N, Gamble GP, et al. Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer. J Clin Oncol, 2003, 21(6): 1029-1034.
28. Darling GE, Allen MS, Decker PA, et al. Number of lymph nodes harvested from a mediastinal lymphadenectomy: results of the randomized, prospective American College of Surgeons Oncology Group Z0030 trial. Chest, 2011, 139(5): 1124-1129.
29. Riquet M, Pricopi C, Legras A, et al. Can mathematics replace anatomy to establish recommendations in lung cancer surgery? J Thorac Dis, 2017, 9(3): E327-E332.
30. Doddoli C, Aragon A, Barlesi F, et al. Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer? Eur J Cardiothorac Surg, 2005, 27(4): 680-685.
31. Lardinois D, Suter H, Hakki H, et al. Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg, 2005, 80(1): 268-274.
32. Massard G, Ducrocq X, Kochetkova EA, et al. Sampling or node dissection for intraoperative staging of lung cancer: a multicentric cross-sectional study. Eur J Cardiothorac Surg, 2006, 30(1): 164-167.
33. Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg, 2006, 81(3): 1013-1019.
34. Izbicki JR, Passlick B, Pantel K, et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg, 1998, 227(1): 138-144.
35. Veronesi G, Maisonneuve P, Pelosi G, et al. Screening-detected lung cancers: is systematic nodal dissection always essential? J Thorac Oncol, 2011, 6(3): 525-530.
36. Zhang Y, Sun Y, Shen L, et al. Predictive factors of lymph node status in small peripheral non-small cell lung cancers: tumor histology is more reliable. Ann Surg Oncol, 2013, 20(6): 1949-1954.
37. Ishida T, Yano T, Maeda K, et al. Strategy for lymphadenectomy in lung cancer three centimeters or less in diameter. Ann Thorac Surg, 1990, 50(5): 708-713.
38. Flores RM, Nicastri D, Bauer T, et al. Computed tomography screening for lung cancer: mediastinal lymph node resection in stage ia nonsmall cell lung cancer manifesting as subsolid and solid nodules. Ann Surg, 2017, 265(5): 1025-1033.
39. Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology, 2013, 266(1): 304-317.
40. Cheng X, Zheng D, Li Y, et al. Tumor histology predicts mediastinal nodal status and may be used to guide limited lymphadenectomy in patients with clinical stage I non-small cell lung cancer. J Thorac Cardiovasc Surg, 2018, 155(6): 2648-2656.
41. Asamura H, Nakayama H, Kondo H, et al. Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis. J Thorac Cardiovasc Surg, 1999, 117(6): 1102-1111.
42. Okada M, Tsubota N, Yoshimura M, et al. Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinomas: role of subcarinal nodes in selective dissection. J Thorac Cardiovasc Surg, 1998, 116(6): 949-953.
43. Boffa DJ, Kosinski AS, Paul S, et al. Lymph node evaluation by open or video-assisted approaches in 11,500 anatomic lung cancer resections. Ann Thorac Surg, 2012, 94(2): 347-353.
44. Merritt RE, Hoang CD, Shrager JB. Lymph node evaluation achieved by open lobectomy compared with thoracoscopic lobectomy for N0 lung cancer. Ann Thorac Surg, 2013, 96(4): 1171-1177.
45. Yang HX, Woo KM, Sima CS, et al. Long-term survival based on the surgical approach to lobectomy for clinical stage i nonsmall cell lung cancer: comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy. Ann Surg, 2017, 265(2): 431-437.
46. Palade E, Passlick B, Osei-Agyemang T, et al. Video-assisted vs open mediastinal lymphadenectomy for Stage I non-small-cell lung cancer: results of a prospective randomized trial. Eur J Cardiothorac Surg, 2013, 44(2): 244-249.
47. Liang H, Liang W, Zhao L, et al. Robotic versus video-assisted lobectomy/segmentectomy for lung cancer: a meta-analysis. Ann Surg, 2018, 268(2): 254-259.
48. Association of Directors of Anatomic and Surgical Pathology. Recommendations for processing and reporting of lymph node specimens submitted for evaluation of metastatic disease. Am J Clin Pathol, 2001, 115(6): 799-801.
49. Osarogiagbon RU, Allen JW, Farooq A, et al. Objective review of mediastinal lymph node examination in a lung cancer resection cohort. J Thorac Oncol, 2012, 7(2): 390-396.
50. Osarogiagbon RU, Sareen S, Eke R, et al. Audit of lymphadenectomy in lung cancer resections using a specimen collection kit and checklist. Ann Thorac Surg, 2015, 99(2): 421-427.
51. Ramirez RA, Wang CG, Miller LE, et al. Incomplete intrapulmonary lymph node retrieval after routine pathologic examination of resected lung cancer. J Clin Oncol, 2012, 30(23): 2823-2828.
52. Huang X, Wang J, Chen Q, et al. Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis. PLoS One, 2014, 9(10): e109979.
53. Weijs TJ, Ruurda JP, Luyer MD, et al. Preserving the pulmonary vagus nerve branches during thoracoscopic esophagectomy. Surg Endosc, 2016, 30(9): 3816-3822.