Author of

• 25970

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  P3.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 982)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall

  • 27772

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    P3.16-30 - The Impact of the Surgical Approach on Lymph Node Upstaging in Curative Intent Lung Cancer Surgery (ID 13926)

    12:00 - 13:30  |  Author(s): Kaid Darwiche
    • Abstract

    Background
    

    Radical mediastinal lymphadenectomy is an essential part of lung cancer surgery. The purpose of preoperative mediastinal staging is to identify patients who benefit from induction treatment. However, even in early stage lung cancer some patients present with N1 or N2 disease only intra- or even post-operatively. Accordingly, this study aims to evaluate the impact of different surgical approaches and tumor size on the rate of nodal upstaging.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    We performed an analysis of our prospectively collected database from January 2016 (for robotic assisted surgery January 2015) to March 2018 and nodal upstaging with regard to surgical approach and T status in all patients with early stage T1/T2 NSCLC undergoing primary resection with curative intent.

    4c3880bb027f159e801041b1021e88e8 Result
    

    A total of 452 T1 or T2 stage NSCLC patients were operated with curative intention. Upstaging occurred in 65 cases (14.4%), from which 43 (9.5%) patients had pN1 and 22 (4.9%) had pN2 disease. Staging was performed according to ESTS guidelines. 366 patients (81%) were preoperatively evaluated by PET/CT and/or EBUS. 293 patients received PET/CT and 169 of them had an additional EBUS. 73 patients received EBUS based on conventional staging without PET/CT. There was a significant difference (p=0.01) in upstaging between T1 and T2 tumors (10.5% (7%N1/3.5%N2) and 19.4% (12.8%N1/6.6%N2), respectively). A stratification based on the surgical approach is shown in Table 1.

    

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Irrespective of the surgical approach the rate of N1 upstaging is significantly higher in patients with T2 tumors compared to T1 tumors. The rate of mediastinal upstaging is comparable in both groups. The distribution between T1 and T2 tumors needs to be taken into account when analyzing upstaging rates in primary lung cancer surgery.

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