Video-assisted mediastinoscopic lymphadenectomy (VAMLA): Mature results for staging non-small cell lung cancer with normal mediastinum.

IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Thoracic and Cardiovascular Surgery Pub Date : 2024-11-01 Epub Date: 2024-02-03 DOI:10.1016/j.jtcvs.2024.01.040
Sergi Call, Nina Reig-Oussedik, Carme Obiols, José Sanz-Santos, Juan Manuel Ochoa-Alba, Lucía Reyes Cabanillas, Mireia Serra-Mitjans, Ramón Rami-Porta
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Abstract

Objectives: The aim of this study is to analyze the accuracy of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and the unsuspected (u) N2/3 rates in patients with non-small cell lung cancer (NSCLC) and normal mediastinum by integrated positron emission tomography-computed tomography.

Methods: Prospective observational single-center study of 603 consecutive VAMLAs from 2010 to 2022.

Exclusion criteria: other indications (n = 32), tumors different from NSCLC (n = 91), and clinical (c) N2/3 tumors by positron emission tomography-computed tomography (n = 46). Systematic nodal dissection was the gold standard to validate negative VAMLAs. Those patients with negative VAMLA and missing reference standard test were excluded. uN2/3 rates were analyzed in the global series and in the subgroups of tumors according to their clinical nodal and tumor categories. Pathologic findings were reviewed, and staging values were calculated.

Results: Three hundred eighty-three patients with cN0/1 NSCLC underwent VAMLA. Staging values of VAMLA were: sensitivity, 0.98 (95% CI, 0.92-0.99); negative predictive value, 0.99 (95% CI, 0.98-1); and diagnostic accuracy, 0.99 (95% CI, 0.98-1). The uN2/3 rate for the whole series (N = 383) was 18.8%. The uN2/3 rates according to presurgical nodal and tumor categories determined by positron emission tomography computed tomography were: 3.6% (4 out of 111) in cT1N0; 16.3% (18 out of 110) in cT2N0; 10.25% (4 out of 39) in cT3N0; and 32% (7 out of 22) in cT4N0. Forty-two percent (39 out of 93) in cN1; complication rate was 7%.

Conclusions: This series of NSCLC with normal mediastinum staged by VAMLA demonstrates a high accuracy of this technique and a high rate of uN2/3 disease (specially in cN1 and cT4N0). VAMLA could be considered the reference staging procedure for staging cN0/1 NSCLC.

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视频辅助纵隔镜淋巴腺切除术(VAMLA):对纵隔正常的非小细胞肺癌进行分期的成熟结果。
研究目的本研究旨在通过正电子发射断层扫描(PET)-计算机断层扫描(CT)综合分析视频辅助纵隔镜淋巴腺切除术(VAMLA)的准确性以及非小细胞肺癌(NSCLC)和正常纵隔患者的未怀疑(u)N2-3率:排除标准:其他适应症(32例);不同于NSCLC的肿瘤(91例);PET-CT显示的cN2-3肿瘤(46例)。系统性结节解剖是验证 VAMLA 阴性的金标准。根据临床结节和肿瘤类别,分析了总体系列和亚组肿瘤的 uN2-3 率。对病理结果进行复查,并计算分期值:结果:383例临床(c) N0-1 NSCLC患者接受了VAMLA。VAMLA的分期值为:敏感性0.98(95% CI:0.92- 0.99);阴性预测值0.99(95% CI:0.98-1);诊断准确性0.99(95% CI:0.98-1)。整个系列(n=383)的uN2-3率为18.8%。根据 PET-CT 确定的手术前结节和肿瘤类别,uN2-3 率为cT1N0为3.6%(4/111);cT2N0为16.3%(18/110);cT3N0为10.25%(4/39);cT4N0为32%(7/22)。cN1为42%(39/93);并发症发生率为7%:7%:这组纵隔正常的NSCLC患者采用VAMLA分期显示了该技术的高准确性和uN2-3疾病的高发生率(尤其是cN1和cT4N0)。VAMLA可被视为对cN0-1 NSCLC进行分期的参考分期程序。
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来源期刊
CiteScore
11.20
自引率
10.00%
发文量
1079
审稿时长
68 days
期刊介绍: The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.
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