Author of

• 10643

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  P1.07 - Poster Session 1 - Surgery (ID 184)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10686

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    P1.07-043 - Surgical management of Left Non-Small-Cell Lung Cancer with ipsilateral and contralateral mediastinal node metastasis (N2 and N3α disease) by Systemic extended bilateral mediastinal dissection (Hata's method) (ID 3033)

    09:30 - 16:30  |  Author(s): T. Yokota
    • Abstract

    Background
    The role of surgery in the treatment of non-small-cell lung cancer　(NSCLC) with clinically manifested mediastinal lymph node metastasis is controversial. But, the removal of the whole regional lymphatic system together with primary tumor is one of the fundamental rules in oncological surgery.　Systemic nodal dissection（SND） has been accepted by the IASLC to be an important component of intrathoracic staging. Studies addressing the survival benefit of mediastinal lymph node dissection have been inconclusive.　 According to the study of regional lymphatic drainage, we considered reasonable lymphadenectomy contributes the post-operative survival of the patient with NSCLC. And we had devised Systemic extended bilateral mediastinal dissectionand lung resection through a median sternotomy (ND3 operation (Hata’s method)), and reported that ND3 operation can allow for complete dissection of all stations of mediastinal lymph nodes.

    Methods
    This is a retrospective study of 28１ patients [198 male and 83 female, mean ages 59.5 years (range, 38-75)], underwent ND3 operation due to Left NSCLC, from January 1990 till December 2012. The patients with Lt. NSCLC who are estimated to be able to conventional radical operation and aged 75 year-old or less becomes the adaptation of our ND3 operation. All patients had assessed pathologically stageI-IIIB, underwent R0 operation. The operation were performed through the median sternotomy. As N3αoperation, bilateral mediastinal nodal dissection including bilateral thoracic inlet and lung resection is performed. Lymph node station #1,#2R,#4R,#2L,#4L,#3a,#5,#6,#7,(#8,#9:Left lower NSCLC) were removed.

    Results
    Postoperative survival rates calculated with Kaplan-Meier method. The clinicopathological data of patients and surgeical outcomes were evaluated. The overall 5-year survival rate in the 28１ patients of left lung primary was 64.1%. Operative mortality in 28１ patients was 3.2%(２００１-２０１２：1.3%). Lymph node metastasis to the mediastinum was confirmed in 89 (31.6%) patients. (pN2 was 50 patients,pN3α was 26 patients, pN3β was 2 patients, pN3γ was 11 patients) Five-year survival rate was 54.5% in cN2(n=47) caces, 49.1% in pN2 cases(n=50), 44.1% in cN3α(n=18), 40.2% in pN3α(n=26), and 53.3% in p-stageIIIA・pN2 (n=46). In these stageIIIA・pN2 caces, no significant difference in survival were found regarding age, sex, tumor location, histologic type, tumor size, clinical N stage (accidental N2 or not), the number of metastatic nodal station (single-station N2 or multi-station N2). There was significant difference in survival regarding recurrence after surgery. ( Five-year survival rate was 42.2% in recurrence cases (n=28), 68.6% in no recurrence cases(n=18)) The patients with N2 disease who have no distant micrometasis can obtain oncological benefit from our ND3 operation.　

    Conclusion
    N2 and N3α Lt.NSCLC. And better local tumor control than conventional lung operation after complete resection for N2 and N3α disease without leading to increase morbidity. It is important to perform curative operation with complete　dissection of all station of mediastinal lymph nodes.

• 12495

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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12527

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    P3.07-032 - Systemic extended bilateral mediastinal lymph node dissection through a median sternotomy with non-small cell carcinoma of the right upper lobe. (ID 2497)

    09:30 - 16:30  |  Author(s): T. Yokota
    • Abstract

    Background
    Metastasis to mediastinal lymph nodes is a significant negative prognostic factor for NSCLC in spite of a localized presentation. According to the results of Hata’s study on the vital lymphdrainage from each segmental bronchus, the predictable N3 stations of lymphatic spread of cancer cells are the contra-lateral mediastinal nodes. Therefore, we have considered that it would be valuable to perform Systemic extended bilateral mediastinal dissection and lung resection through a median sternotomy (ND3 operation, Hata’s method). And we had devised ND3 operation for patient with NSCLC of the left lung. So far, we reported effectiveness of N3α operation (Hata’s method) in patients with lymph node metastasis to the mediastinum in NSCLC of the left lung. From January 1990 ,we have also applied N3α operation (Hata’s method) to patients with NSCLC of the right upper lobe.

    Methods
    We retrospectively analyzed the clinical records of patients who underwent ND3 operation (R0 resection) for NSCLC of the right upper lobe. Patients who had incomplete resection (R1,R2), stageIV disease were excluded from this analysis. The patients with NSCLC who are estimated to be able to conventional radical operation and aged 75 year-old or less becomes the adaptation of ND3 operation. From January 1990 to December 2012, 195 patients of the right upper lobe primary underwent ND3 operation completely (R0 resection) and we reviewed these cases. Survival estimates were calucurated by The Kaplan-Meier method and compared using the log-rank test.

    Results
    Overall 5-year survival rate in 195 patients, including operation-related deaths and deaths due to unrelated diseases, was 55.4%. In these 195 patients, the five-year survival rate according to pathological stages were 90% in 35 pts of stageIA, 70.6% in 48 pts of p-stageIB , 57.5% in 19 pts of stageIIA, 47.9% in 18 pts of p-stageIIB, 42.1% in 45 pts of p-stageIIIA, 18.1% in 30 pts of p-stageIIIB. And the 5-year survival rate according to nodal involvement, 70.9% in 109 pts of N0, 46.2% in 22 pts of N1, 41.5% in 41 pts of N2, and 19% in 14 pts of N3γ. Operative mortality in 195 patients of right upper lobe primary NSCLC was 5 patients (2.6%).

    Conclusion
    In this nonrandomized comparison, the post-operative survival of patients with p-N2 NSCLC of the right upper lobe would be improved by our Systemic Bilateral Mediastinal Dissection. To improve survival rate, it is important to perform curative operation with complete　dissection of all station of mediastinal lymph nodes.