Intentional Left Upper Mediastinal Node Dissection for Lung Cancer under VATS Compared with Thoracotomy

Shin-ichi Yamashita, Takeshi Shiraishi, Akinori Iwasaki, Masafumi Hiratsuka, Yasuhiro Yoshida, Ryuichi Waseda, Naoko Imamura, Asahi Nagata, Kozo Yamamoto, Ryo Mori

Fukuoka University, Fukuoka, Japan

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–C

Abstract

Objectives: Left upper mediastinal node dissection (LUMND) under video-assisted thoracoscopic surgery (VATS) may be more difficult than thoracotomy. The aim of this study is to assess quality of left upper mediastinal node dissection, especially left lower paratracheal node (4L) dissection.

Patients and Methods: 60 patients with lung cancer located in left upper lobe were operated between January 2013 and December 2016 in our institute. Of those, 33 VATS lobectomy and 27 open lobectomy were compared in terms of dissected node number. Intentional LUMND in VATS is defined as MND including left lower paratracheal node (4L) dissection with curative intent and non-intentional LUMND is sampling of 4L. Our procedures of LUMND is that left recurrent ralyngeal nerve is isolated from Botallo ligamentum and completely isolated as far as possible by endoscissors. 4L are dissected from trachea and left main bronchus both distal and proximal direction. Dissected lymph node number was compared between intentional and non-intentional LUMND.

Results: VATS LUMND showed tendency of less lymph node number compared with open procedure (mean; VATS, 4.8 vs open, 7.1, p=0.05), regardless of no difference of 4L (mean; VATS, 2.1 vs open, 2.6). Intentional LUMND (n=13) was superior to non-intentional LUMND (n=20) under VATS regarding all upper nodes (mean; intentional, 7.4 vs non-intentional, 3.1, p=0.009) and 4L (mean; intentional, 4.5 vs non-intentional, 0.6, p=0.005). Tendency of open procedure superiority against VATS was disappeared after comparison with intentional LUMND (mean; intentional, 7.4 vs open, 7.1, p=0.83) and 4L (mean; intentional, 4.5 vs open, 2.6, p=0.09). Dissected node number of intentional group was significantly higher than non-intentional group without increased morbidity. (p=0.001).

Conclusions: Our study demonstrated that intentional LUMND was not inferior to open procedure in terms of dissected lymph node number. VATS LUMND may be promising oncological outcomes under node dissection with curative intent.