A prospective trial of systematic nodal dissection for lung cancer by video-assisted thoracic surgery: can it be perfect?
BACKGROUND
There have been no reports evaluating the completeness of systematic nodal dissection with video-assisted thoracic surgery (VATS). In order to elucidate the completeness of the dissection, we have conducted a prospective trial with patients having primary lung cancer.


METHODS
Patients with clinical stage I lung cancer were the candidates for this study. Thoracotomy was performed with a small skin incision of 7 cm to 8 cm in length. Through these small wounds and two trocars, pulmonary resection was performed and then hilar and mediastinal lymph nodes were dissected. After that, a standard thoracotomy was carried out by another surgeon to complete systematic nodal dissection.


RESULTS
Video-assisted thoracic surgery lobectomy with lymph node dissection was accomplished in 17 right lung cancer patients and 12 left lung cancer patients. On the right side, the average numbers of resected lymph nodes by VATS and remnant lymph nodes were 40.3 and 1.2, respectively. The average weights of dissected tissues by VATS and remnant tissues were 10.0 g and 0.2 g, respectively. On the left side, there were 37.1 and 1.2 lymph nodes and 8.3 g and 0.2 g of weight of dissected tissues. No nodal involvement was observed in the remnant lymph nodes.


CONCLUSIONS
The lymph node dissection with VATS was technically feasible and the remnant ("missed" by VATS) lymph nodes and tissues were 2% to 3%, which seems acceptable for clinical stage I lung cancer.
Sagawa
Motoyasu
M
Department of Thoracic Surgery, Institute of Development Aging and Cancer, Tohoku University, Sendai, Japan. sagawam@kanazawa-med.ac.jp
Sato
Masami
M
Sakurada
Akira
A
Matsumura
Yuji
Y
Endo
Chiaki
C
Handa
Masashi
M
Kondo
Takashi
T
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted