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Marcin Zielinski



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    MS06 - An Interdisciplinary Approach to Optimal Nodal Staging (ID 69)

    • Event: WCLC 2019
    • Type: Mini Symposium
    • Track: Staging
    • Presentations: 1
    • Now Available
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      MS06.05 - Transcervical Lymphadenectomies (Now Available) (ID 3471)

      11:00 - 12:30  |  Presenting Author(s): Marcin Zielinski

      • Abstract
      • Presentation
      • Slides

      Abstract

      Abstract

      Introduction:

      The aim of his study is to analyze the issue of transcervical lympadenectomies for Non-Small-Cell Lung Cancer performed by the techniques of Video-Assisted Mediastinoscopic Lymphadenectomy (VAMLA) and Transcervical Extended Mediastinal Lymphadenectomy (TEMLA).

      Methods

      The Pubmed search was performed and there were 27 articles found on VAMLA and 33 articles on TEMLA. After further analysis there were 13 original article on VAMLA and 18 original articles on TEMLA. In the current paper all proven and possible advantages of transcervical lymphadenectomies representd by VAMLA and TEMLA are described.

      Results

      The proven advantages of VAMLA and TEMLA:

      1. Superior diagnostic value in discovery of the metastatic mediastinal nodes for staging and restaging of NSCLC.

      2. bilateral mediastinal lymphadenectomy, more extensive than the techniques of lymphadenectomy used during standard thoracotomy or Video-Assisted Thoracic Surgery (VATS) approaches.

      Possible advantages include:

      1. Improved selection of patients for pulmonary resection for NSCLC

      2. Combination of VAMLA/TEMLA with VATS pulmonary resection,

      3. Combination of VAMLA/TEMLA with esophegeal resection,

      4. Combination of TEMLA and Stereotactic Radiotherapy (SBRT) for advanced NSCLC

      5. The use of TEMLA for preoperative staging of mesothelioma,

      6. Combination of TEMLA and pulmonary lobectomy through a sole transcevical approach

      7. Resection of various metastatic tumors, including thyroid cancer and metastatic mediastinal nodes.

      8. Possible impact of VAMLA/TEMLA on improvement of survival for NSCLC patients, which is the most important issue. In case of VAMLA superior survival of patients operated on with the use pulmonary resection with VAMLA in comparison to the pulmonary resection with addition of standard mediastinoscopy. In case of TEMLA no reports on survival has been published, yet

      Disadvantages of VAMLA/TEMLA include

      1. Possible complications, especially the left recurrent nerve palsy

      2. Possible delay or elimination of some patients from pulmonary resection due to postoperative complication in case of negative result of VAMLA/TEMLA

      3. Scar in the neck (cosmetic)

      4. Demanding surgical technique

      Conclusions

      1. Bilateral transcervical lymphadenectomies representd by VAMLA and TEMLA are more extensive than the techniques of lymphadenectomy used during standard thoracotomy or Video-Assisted Thoracic Surgery (VATS) approaches and superior to the other techniques of staging and restaging of NSCLC in regard to the diagnostic value.

      2. There are several other possible advantages of TEMLA/VAMLA for the treatment of NSCLC, esophageal cancer, mediastinal tumors and malignant mesothelioma.

      3. Possible impact of VAMLA/TEMLA on survival of NSCLC has not been proven, yet.

      References

      Hurtgen M, Friedel G, Toomes H et al: Radical video-assisted mediastinoscopic lymphadenectomy (VAMLA) – technique and first results. Eur J Cardiothorac Surg 2002;21:348-51

      Zielinski M, Szlubowski A, Kołodziej M, Orzechowski S, Laczynska E, Pankowski J, Jakubiak M, Obrochta A. Comparison of endobronchial ultrasound and/or endoesophageal ultrasound with transcervical extended mediastinal lymphadenectomy for staging and restaging of non-small-cell lung cancer. J Thorac Oncol. 2013 May;8(5):630-6.

      Zielinski M, Hauer J, Hauer L, Pankowski J, Nabialek T, Szlubowski A. Staging algorithm for diffuse malignant pleural mesothelioma. Interact Cardiovasc Thorac Surg. 2010;10:185-9

      Zieliński M, Pankowski J, Hauer L et al: The right upper lobe pulmonary resection performed through the transcervical approach. Eur J Cardiothorac Surg. 2007;32:766-769

      Singh AK, Hennon M, Ma SJ, Demmy TL, Picone A, Dexter EU, Nwogu C, Attwood K, Tan W,, Hermann GM, Fung-Kee-Fung S, Malhotra HK, Yendamuri S, Gomez-Suescun JA. A pilot study of stereotactic body radiation therapy (SBRT) after surgery for stage III non-small cell lung cancer. BMC Cancer. 2018 Nov 29;18(1):1183. doi: 10.1186/s12885-018-5039-5.

      Turna A, Demirkaya A, Ozkul S, Oz B, Gurses A, Kaynak K. Video-assisted mediastinoscopic lymphadenectomy is associated with better survival than mediastinoscopy in patients with resected non-small cell lung cancer. J Thorac Cardiovasc Surg. 2013 Oct;146(4):774-80. doi: 10.1016/j.jtcvs.2013.04.036. Epub 2013 Jun 15.

      Li X, Wang W,, Zhou Y, Yang D, Wu J, Zhang B, Wu Z, Tang J.. Efficacy comparison of transcervical video-assisted mediastinoscopic lymphadenectomy combined with left transthoracic esophagectomy versus right transthoracic esophagectomy for esophageal cancer treatment. World J Surg Oncol. 2018 Feb 9;16(1):25. doi: 10.1186/s12957-017-1268-3.

      Call S, Obiols C, Rami-Porta R, Trujilo-Reyes JC, Iglesias M, Saumench R, Gonzalez-Pont G, Serra-Mitjans M, Belda-Sanchís J. Video-Assisted Mediastinoscopic Lymphadenectomy for Staging Non-Small Cell Lung Cancer. Ann Thorac Surg. 2016 Apr;101(4):1326-33. doi: 10.1016/j.athoracsur.2015.10.073. Epub 2016 Jan 21.

      .Kim HJ, Kim YH, Choi SH, Kim HR, Kim DK, Park SI. Video-assisted mediastinoscopic lymphadenectomy combined with minimally invasive pulmonary resection for left-sided lung cancer: feasibility and clinical impacts on surgical outcomes†. Eur J Cardiothorac Surg. 2016 Jan;49(1):308-13. doi: 10.1093/ejcts/ezv077. Epub 2015 Mar 11

      Zielinski M. Transcervical Resection of the Mediastinal Tumors. In Zielinski M, Rami-Porta R (eds). Transcervical Approach in Thoracic Surgery. Springer 2014, pages 141-148.

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    P2.13 - Staging (ID 315)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Staging
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.13-02 - Persistent Occult Micrometastases in Mediastinal Lymph Nodes Are Associated with Reduced Survival After Neoadjuvant Therapy (ID 1871)

      10:15 - 18:15  |  Author(s): Marcin Zielinski

      • Abstract

      Background

      This study was undertaken to evaluate the utility of the detection of occult micrometastases (OM) by immunohistochemical (IHC) staining of mediastinal lymph nodes (LN) obtained during surgical restaging after neoadjuvant treatment of NSCLC patients with mediastinal LN metastases.

      Method

      In years 2007-2018, 55 patients with pathologically confirmed mediastinal LN metastases were restaged with TEMLA (transcervical extended mediastinal lymphadenectomy) after neoadjuvant chemotherapy or chemoradiotherapy. Routine haematoxylin&eosin staining of harvested mediastinal LN showed no metastases and all patients subsequently underwent curative pulmonary resection. To detect OM, we retrospectively performed IHC staining with anticytokeratin antibodies on all (1613) mediastinal LN obtained during TEMLA.

      Result

      Persistent OM were found in mediastinal LN of 7 patients (12,7%). In all cases, only single LN was affected. After a median observation period of 24 months (range 4 to 60) after curative surgery, OM+ patients showed significantly reduced overall survival in comparison to OM- patients (log-rank, p=0.035). In Cox multivariable analysis, OM persistence was independent negative factor for overall survival.

      Conclusion

      IHC staining of mediastinal LN obtained during TEMLA allows for more accurate restaging. Persistent mediastinal OM after neoadjuvant treatment are associated with reduced survival after pulmonary resection.