In Surgical Treatment of Non-Small-Cell Lung Cancer a Minimum Number of Resected Mediastinal Lymph Nodes Is Mandatory for Accurate Staging ()
ABSTRACT
Objective: Increased
numbers of removed lymph nodes (LN) are resulting in more accurate staging of
the patient (Will-Rogers-Phenomenon). This study evaluates dependence of lymph
node sample size to 1) Will-Rogers-Phenomenom, 2) influence of sample size on
overall survival and in terms of
3) morbidity and mortality. Methods: 131 patients after pulmonary resection
were retrospectively analysed
concerning surgery, number of removed lymph nodes, stage, complications and
survival. Patients were stratified according to the median number of lymph
nodes in two groups (A <12 lymph nodes and B ≥12 lymph nodes). Results: 5%
of the patients had only local lymphadenectomy and in 14% a systematic
lymphadenectomy was performed. 17% of the patients showed skip metastasis.
Lymph node positivity was correlated to the number of removed lymph nodes (p =
0.003). The approximated median survival for UICC (Union internationale contre
le cancer) stage I was 511, stage II 521 and stage III 290 days. Subgroup
analysis of survival data showed in group A an approximated median survival at
stage I of 495 days, at II 537 days and at III 451.5 days. Group B showed at
stage I 675 days, at II 521 days and at III 221 days. There was no difference
in complications and mortality. Conclusion: A too low sample size leads to
understaging due to skip metastasis. Obligatory mediastinal lymph node sampling
would decrease the risk of understaging due to skip metastasis and does not
increase morbidity or complications. Lymph node sampling is not inferior
concerning morbidity and survival in our patient collective. This study cannot
recommend a minimum number of LN to be resected. The evaluated limit of 12 LN
proves to be suitable as a guideline.
Share and Cite:
Kolb, A. , Steidele, E. , Matthews, C. , Merk, J. , Orend, K. and Mühling, B. (2014) In Surgical Treatment of Non-Small-Cell Lung Cancer a Minimum Number of Resected Mediastinal Lymph Nodes Is Mandatory for Accurate Staging.
Surgical Science,
5, 471-478. doi:
10.4236/ss.2014.510072.
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