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Interact Cardiovasc Thorac Surg. 2015 Jun;20(6):791-6. doi: 10.1093/icvts/ivv062. Epub 2015 Mar 24.

Clinicopathological characteristics and lymph node metastasis pathway of non-small-cell lung cancer located in the left lingular division.

Author information

1
Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
2
Department of General Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
3
Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka, Japan.
4
Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Osaka, Japan.
5
Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan.
6
Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan.
7
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
8
Department of General Thoracic Surgery, Okayama University Hospital, Okayama, Japan smiyoshi@md.okayama-u.ac.jp.

Abstract

OBJECTIVES:

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.

KEYWORDS:

Left lingular division; Lymph node metastasis; Non-small-cell lung cancer; Selective mediastinal lymph node dissection

PMID:
25805399
DOI:
10.1093/icvts/ivv062
[Indexed for MEDLINE]

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