The effects of lymph node dissection techniques on the survival of geriatric patients with non-small cell lung cancer

Yıl 2022, Cilt: 3 Sayı: 1, 13 - 17, 31.01.2022

Mustafa Vedat Doğru , Celal Buğra Sezen , Cemal Aker , Fatma Tokgöz Akyıl , Muzaffer Metin

Öz

Background: Lymph nodes are the most important prognostic factors in lung cancer. Controversy still continues on lymph nodes prognosis. This study aims to evaluate the effects of lymph node dissection techniques on survival in geriatric patients.

Methods: The study was conducted retrospectively in patients who were operated on for non-small cell lung cancer (NSCLC) between 2007 and 2016. Lobe-specific lymph node dissection (LsLND) was performed in 77 patients, while complete (systematic) lymph node dissection (SLND) was performed in 206 patients.

Results: A total of 283 patients were included in the study, of which 258 were male (91.2%) and 25 were female (8.8%). The median age of the patients was 69 years (IQR: 65-84). The mean survival time of the patients was 46 months, and the 5-year survival rate was 38.9%. The survival rate in pN2 disease was 15.6%, while the survival rate in pN0 disease was 46%. While the 5-year survival rate was 34.4% in patients who underwent lobe-specific lymph node sampling, it was 40.5% in patients who underwent systematic lymph node dissection (p=0.147).

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Conclusions: As a result of our study, no difference was found in terms of survival between lobe-specific lymph node dissection or systematic lymph node dissection in the geriatric age group. Especially pN2 disease, histopathological, and resection width were observed among the most important prognostic factors affecting survival. Therefore, we think lobe-specific lymph node sampling may be preferred instead of performing complete-systematic lymph node dissection in advanced ages because of less morbidity.

Anahtar Kelimeler

Lymph node dissection, Lung Cancer, Survival

Kaynakça

• 1. Dogru MV, Sezen CB, Erdogu V, Aker C, Alp A, Erduhan S, Et al. Prognostic factors of operated stage ı non-small cell lung cancers: A tertiary center long-term outcomes. Med Bull Haseki 2021;59:221-227
• 2. Sezen AI, Sezen CB, Sokulmez Yildirim S, Dizbay M, Ulutan F. Cost analysis and evaluation of risk factors for postoperative pneumonia after thoracic and cardiovascular surgery: a single-center study. Curr Thorac Surg 2019;4(2):56-62.
• 3. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA: a cancer journal for clinicians. 2011;61(2):69–90.
• 4. Li Z, Chen W, Xia M, Liu H, Liu Y, Inci I, et al. Sleeve lobectomy compared with pneumonectomy for operable centrally located non-small cell lung cancer: a meta-analysis. Transl Lung Cancer Res. 2019;8(6):775-786.
• 5. Darling GE. Lymph node assessment in early stage non-small cell lung cancer lymph node dissection or sampling? Gen Thorac Cardiovasc Surg. 2020;68(7):716-724.
• 6. Dezube AR, Mazzola E, Bravo-Iñiguez CE, De León LE, Rochefort MM, Bueno R, et al. Analysis of lymph node sampling minimums in early stage non-small-cell lung cancer. Semin Thorac Cardiovasc Surg. 2021;33(3):834-845.
• 7. Watanabe S. Lymph node dissection for lung cancer: past, present, and future. Gen Thorac Cardiovasc Surg. 2014;62(7):407-14.
• 8. Lardinois D, De Leyn P, Van Schil P, Porta RR, Waller D, Passlick B, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg. 2006;30(5):787-92.
• 9. Sugi K, Nawata K, Fujita N, Ueda K, Tanaka T, Matsuoka T, et al. Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter. World J Surg. 1998;22(3):290-4; discussion 294-5.
• 10. Hata E. Rationale for extended lymphadenectomy for lung cancer. Theor Surg. 1990;5:19–25.
• 11. Gajra A, Newman N, Gamble GP, Kohman LJ, Graziano SL. Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer. J Clin Oncol. 2003;21(6):1029-34.
• 12. Watanabe S, Asamura H, Suzuki K, Tsuchiya R. The new strategy of selective nodal dissection for lung cancer based on segment-specific patterns of nodal spread. Interact Cardiovasc Thorac Surg. 2005;4(2):106-9.
• 13. Kato H, Ichinose Y, Ohta M, Hata E, Tsubota N, Tada H, et al; Japan Lung Cancer Research Group on Postsurgical Adjuvant Chemotherapy. A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med. 2004;350(17):1713-21.
• 14. Aokage K, Yoshida J, Ishii G, Hishida T, Nishimura M, Nagai K. Subcarinal lymph node in upper lobe non-small cell lung cancer patients: is selective lymph node dissection valid? Lung Cancer. 2010;70(2):163-7.
• 15. Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H. Prognosis of completely resected pN2 non-small cell lung carcinomas: What is the significant node that affects survival? J Thorac Cardiovasc Surg. 1999;118(2):270-5.
• 16. Nakao M, Ichinose J, Matsuura Y, Okumura S, Mun M. Outcomes after thoracoscopic surgery in octogenarian patients with clinical N0 nonsmall- cell lung cancer. Jpn J Clin Oncol. 2020;50(8):926-932.
• 17. Tulay CM, Sivrikoz MC, Ak İ, Çiftçi ÖD, Akçay EÖ, Dündar E. Sentinel lymph node mapping in early stage non-small cell lung carcinoma. Turk Gogus Kalp Dama. 2013;21:416–21.
• 18. Turna A, Solak O, Kilicgun A, Metin M, Sayar A, Gürses A. Is lobe-specific lymph node dissection appropriate in lung cancer patients undergoing routine mediastinoscopy? Thorac Cardiovasc Surg. 2007;55(2):112-9.
• 19. Sezen CB, Gokce A, Kalafat CE, Aker C, Tastepe AI. Risk factors for postoperative complications and long-term survival in elderly lung cancer patients: a single institutional experience in Turkey. Gen Thorac Cardiovasc Surg. 2019;67(5):442-449.