Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.

Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry / Bertani A.; Gonfiotti A.; Nosotti M.; Ferrari P.A.; De Monte L.; Russo E.; Di Paola G.; Solli P.; Droghetti A.; Bertolaccini L.; Crisci R.; Curcio C.; Amore D.; Marulli G.; Nicotra S.; De Negri A.; Maineri P.; di Rienzo G.; Lopez C.; Morelli A.; Londero F.; Spaggiari L.; Gasparri R.; Baietto G.; Casadio C.; Infante M.; Benato C.; Alloisio M.; Bottoni E.; Cardillo G.; Carleo F.; Stella F.; Dolci G.; Puma F.; Vinci D.; Cavallesco G.; Maniscalco P.; Ampollini L.; Carbognani P.; Terzi A.; Viti A.; Negri G.; Bandiera A.; Perkmann R.; Zaraca F.; Andretti C.; Poggi C.; Mucilli F.; Camplese P.; Luzzi L.; Ghisalberti M.; Imperatori A.; Rotolo N.; Bortolotti L.; Rizzardi G.; Torre M.; Rinaldo A.; Sabbatini A.; Refai M.; Benvenuti M.R.; Benetti D.; Stefani A.; Natali P.; Lausi P.; Guerrera F.. - In: JOURNAL OF THORACIC DISEASE. - ISSN 2072-1439. - STAMPA. - 9:(2017), pp. 2061-2070. [10.21037/jtd.2017.06.12]

Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry

Gonfiotti A.;
2017

Abstract

Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.
2017
9
2061
2070
Goal 3: Good health and well-being for people
Bertani A.; Gonfiotti A.; Nosotti M.; Ferrari P.A.; De Monte L.; Russo E.; Di Paola G.; Solli P.; Droghetti A.; Bertolaccini L.; Crisci R.; Curcio C.;...espandi
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1193551
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