Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.

Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry

Cavallesco, Giorgio;Maniscalco, Pio;Stefani, Alessandro;
2017

Abstract

Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.
Bertani, Alessandro; Gonfiotti, Alessandro; Nosotti, Mario; Ferrari, Paolo Albino; De Monte, Lavinia; Russo, Emanuele; Di Paola, Gioacchino; Solli, Piero; Droghetti, Andrea; Bertolaccini, Luca; Crisci, Roberto; Curcio, Carlo; Amore, Dario; Marulli, Giuseppe; Nicotra, Samuele; De Negri, Andrea; Maineri, Paola; di Rienzo, Gaetano; Lopez, Camillo; Morelli, Angelo; Londero, Francesco; Spaggiari, Lorenzo; Gasparri, Roberto; Baietto, Guido; Casadio, Caterina; Infante, Maurizio; Benato, Cristiano; Alloisio, Marco; Bottoni, Edoardo; Cardillo, Giuseppe; Carleo, Francesco; Stella, Franco; Dolci, Giampiero; Puma, Francesco; Vinci, Damiano; Cavallesco, Giorgio; Maniscalco, Pio; Ampollini, Luca; Carbognani, Paolo; Terzi, Alberto; Viti, Andrea; Negri, Giampiero; Bandiera, Alessandro; Perkmann, Reinhold; Zaraca, Francesco; Andretti, Claudio; Poggi, Camilla; Mucilli, Felice; Camplese, Pierpaolo; Luzzi, Luca; Ghisalberti, Marco; Imperatori, Andrea; Rotolo, Nicola; Bortolotti, Luigi; Rizzardi, Giovanna; Torre, Massimo; Rinaldo, Alessandro; Sabbatini, Armando; Refai, Majed; Benvenuti, Mauro Roberto; Benetti, Diego; Stefani, Alessandro; Natali, Pamela; Lausi, Paolo; Guerrera, Francesco
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2387685
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