Thoracoscopic lobectomy with systemic lymph node dissection for lymph node positive non-small cell lung cancer--is thoracoscopic lymph node dissection feasible?
BACKGROUND
The impact of thoracoscopic systemic lymph node dissection (LND) on loco-regional control of non-small cell lung cancer (NSCLC) with positive lymph node metastasis was investigated.


METHODS
Thoracoscopic lobectomy with systemic LND was performed for clinical stage I NSCLC. 340 patients were admitted for either a thoracoscopic (n = 98) or a standard open (n = 242) lobectomy with systemic LND. Of those 340 cases, 75 cases (20 thoracoscopic and 55 open) were pathologically diagnosed with node-positive disease. A retrospective chart review of these 75 cases was performed.


RESULTS
No significant difference in the overall or loco-regional recurrence-free survival was observed between the groups. The results of a multivariate analysis of the overall and the loco-regional recurrence-free survival demonstrated that the significant factors were tumor size for overall recurrence-free survival, and sex and surgical procedure (use of thoracoscopic surgery) for loco-regional recurrence-free survival, respectively.


CONCLUSIONS
In general, thoracoscopic lobectomy for c-stage I disease may have no survival disadvantage over open procedures. It might, however, increase the risk of local recurrence when used to treat pathologically node-positive disease. Caution should be used when treating those cases with thoracoscopic surgery.
Shiraishi
T
T
Department of Surgery II, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka, Japan. tshiraishi-ths@umin,ac.jp
Hiratsuka
M
M
Yoshinaga
Y
Y
Yamamoto
S
S
Iwasaki
A
A
Shirakusa
T
T
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary* / Q000601:surgery; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013906:Thoracoscopy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome