Thoracoscopic segmentectomy with intraoperative evaluation of sentinel nodes for stage I non-small cell lung cancer.

Abstract

OBJECTIVES:

Segmentectomy is the treatment of choice for small-sized non-small cell lung cancer (NSCLC); however, it is difficult to decide the surgical procedure because accurate evaluation of hilar lymph node metastasis remains unclear. We here report the outcome of video-assisted thoracic surgery (VATS) segmentectomy with and without the assessment of sentinel nodes.

MATERIALS AND METHODS:

Eighty-three patients with stage IA NSCLC underwent VATS segmentectomy between January 2003 and December 2010. Twenty patients underwent indocyanine green fluorescence imaging for sentinel node biopsy (SNB) and 63 did not. Intraoperative real-time quantitative RT-PCR to determine the expression of CK-19 was used for evaluation of metastasis. Perioperative outcome, local recurrence rates and survival were compared in both groups.

RESULTS:

Sentinel lymph nodes were identified in 16 of 20 patients (80%) with segmentectomy in the SNB group. The false negative rate was 0%. By RT-PCR for CK-19 expression, only one of these patients showed positive sentinel nodes, which indicated isolated tumor cells; however, segmentectomy was not converted to lobectomy. Seven of 63 patients with VATS segementectomy without SNB and none of the SNB group relapsed. In the relapsed patients without SNB, 4 (6.3%) were local recurrences and 3 (4.7%) were distant metastases. Recurrence-free survival rates in both groups were not significantly different because of the short follow-up period of the SNB group.

CONCLUSIONS:

Our study demonstrated that VATS segmentectomy with SNB was useful for deciding intraoperatively to perform segmentectomy with an accurate lymph node status.

• Authors: Toshihiko Moroga, Shin-ichi Yamashita, Keita Tokuishi, Michiyo Miyawaki, Kentaro Anami, Satoshi Yamamoto, Katsunobu Kawahara
• Journal: Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia (Ann Thorac Cardiovasc Surg) Vol. 18 Issue 2 Pg. 89-94 ( 2012) ISSN: 2186-1005 [Electronic] Japan
• PMID: 22082811 (Publication Type: Journal Article)

Chemical References

• Biomarkers, Tumor
• Fluorescent Dyes
• Keratin-19
• Indocyanine Green

Topics

• Aged
• Aged, 80 and over
• Biomarkers, Tumor (genetics)
• Carcinoma, Non-Small-Cell Lung (genetics, mortality, secondary, surgery)
• Chi-Square Distribution
• Disease-Free Survival
• Female
• Fluorescent Dyes (therapeutic use)
• Humans
• Indocyanine Green
• Intraoperative Care
• Japan
• Kaplan-Meier Estimate
• Keratin-19 (genetics)
• Lung Neoplasms (genetics, mortality, pathology, surgery)
• Lymph Nodes (pathology, surgery)
• Lymphatic Metastasis
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Patient Selection
• Pneumonectomy (adverse effects, methods, mortality)
• Predictive Value of Tests
• Real-Time Polymerase Chain Reaction
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Sentinel Lymph Node Biopsy
• Thoracic Surgery, Video-Assisted (adverse effects, mortality)
• Time Factors
• Treatment Outcome