title: Thoracoscopic segmentectomy with intraoperative evaluation of sentinel nodes for stage I non-small cell lung cancer.
abstract: OBJECTIVE
  Segmentectomy is the treatment of choice for small-sized non-small cell lung cancer (NSCLC); however, it is difficult to decide the surgical procedure because accurate evaluation of hilar lymph node metastasis remains unclear. We here report the outcome of video-assisted thoracic surgery (VATS) segmentectomy with and without the assessment of sentinel nodes.
  
  
  METHODS
  Eighty-three patients with stage IA NSCLC underwent VATS segmentectomy between January 2003 and December 2010. Twenty patients underwent indocyanine green fluorescence imaging for sentinel node biopsy (SNB) and 63 did not. Intraoperative real-time quantitative RT-PCR to determine the expression of CK-19 was used for evaluation of metastasis. Perioperative outcome, local recurrence rates and survival were compared in both groups.
  
  
  RESULTS
  Sentinel lymph nodes were identified in 16 of 20 patients (80%) with segmentectomy in the SNB group. The false negative rate was 0%. By RT-PCR for CK-19 expression, only one of these patients showed positive sentinel nodes, which indicated isolated tumor cells; however, segmentectomy was not converted to lobectomy. Seven of 63 patients with VATS segementectomy without SNB and none of the SNB group relapsed. In the relapsed patients without SNB, 4 (6.3%) were local recurrences and 3 (4.7%) were distant metastases. Recurrence-free survival rates in both groups were not significantly different because of the short follow-up period of the SNB group.
  
  
  CONCLUSIONS
  Our study demonstrated that VATS segmentectomy with SNB was useful for deciding intraoperatively to perform segmentectomy with an accurate lymph node status.
authors.affiliation: Department of Surgery II, Faculty of Medicine, Oita University, Yufu, Oita, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Moroga
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Keita
authors.initials: K
authors.lastname: Tokuishi
authors.forename: Michiyo
authors.initials: M
authors.lastname: Miyawaki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Anami
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Kawahara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000235:genetics; D002289:Carcinoma, Non-Small-Cell Lung / Q000235:genetics / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005456:Fluorescent Dyes / Q000627:therapeutic use; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care; D007564:Japan; D053208:Kaplan-Meier Estimate; D053539:Keratin-19 / Q000235:genetics; D008175:Lung Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011237:Predictive Value of Tests; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D005456:Fluorescent Dyes; D053539:Keratin-19; D007208:Indocyanine Green