title: Clinicopathological characteristics and lymph node metastasis pathway of non-small-cell lung cancer located in the left lingular division.
abstract: OBJECTIVE
  The purpose of this study is to assess the clinicopathological characteristics of non-small-cell lung cancer (NSCLC) occurring in the left lingular division (LLD) in association with a proposal of the LLD-specific regional lymph node stations.
  
  
  METHODS
  Medical records of patients, who underwent complete tumour resection with mediastinal lymph node dissection (MLND) for LLD-NSCLC from 2000 to 2009 in multiple institutions, were retrospectively examined. We analysed patient clinicopathological characteristics and obtained the LLD-specific regional lymph node stations, and then the validity of intraoperative navigation in lymphadenectomy for LLD-NSCLC was investigated.
  
  
  RESULTS
  One hundred and eighty-four LLD-NSCLC patients (97 males and 87 females, and 128 adenocarcinomas and 56 non-adenocarcinomas) were studied. The 5-year overall survival (OS) and disease-free survival (DFS) rates for all LLD-NSCLC patients were 72.9 and 58.3%, respectively. We examined the lymph node metastasis patterns in 42 node-positive tumours. The frequent metastatic lymph node stations were #12u lobar node (n = 22), #5 subaortic node (n = 15) and #11 interlobar node (n = 13) in order. These three node stations were also single metastatic sites in some patients. Metastases to sub-carinal (#7) or inferior mediastinal nodes (#8) were rare. Thus, we assigned the three stations (#5, #11, #12u) as the regional lymph node stations for LLD-NSCLC. If these regional lymph node stations had been examined pathologically during surgery for a total of 160 LLD-NSCLC patients with c-T2N1M0 or lower stage disease, 125 p-N0 and 5 p-N1 patients diagnosed with no metastasis would have been subjected to selective MLND, while 14 p-N1 and all 16 p-N2 patients diagnosed with metastasis would have had complete MLND carried out. As a result, these regional lymph node stations could accurately predict the existence of p-N2 metastasis, and appropriately lead to a selective or complete MLND.
  
  
  CONCLUSIONS
  An intraoperative pathological examination using our proposed LLD-specific regional lymph node stations may accurately diagnose the status of node metastasis, and appropriately lead to selective or complete MLND in LLD-NSCLC patients with c-T2N1M0 or lower stage disease.
authors: Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
authors: Kazuhiko
authors: K
authors: Shien
authors: Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
authors: Shinichi
authors: S
authors: Toyooka
authors: Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
authors: Junichi
authors: J
authors: Soh
authors: Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors: Jiro
authors: J
authors: Okami
authors: Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors: Masahiko
authors: M
authors: Higashiyama
authors: Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
authors: Yoshihisa
authors: Y
authors: Kadota
authors: Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Osaka, Japan.
authors: Hajime
authors: H
authors: Maeda
authors: Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan.
authors: Makio
authors: M
authors: Hayama
authors: Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan.
authors: Masayuki
authors: M
authors: Chida
authors: Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Soichiro
authors: S
authors: Funaki
authors: Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Meinoshin
authors: M
authors: Okumura
authors: Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan smiyoshi@md.okayama-u.ac.jp.
authors: Shinichiro
authors: S
authors: Miyoshi
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Left lingular division; Lymph node metastasis; Non-small-cell lung cancer; Selective mediastinal lymph node dissection