The clinical value of a new method of functional lymph node dissection in video-assisted thoracic surgery right non-small cell lung cancer radical resection

Abstract

Background: To evaluate the safety, thoroughness and feasibility of "tunnel-type en bloc mediastinal lymph node dissection" in video-assisted thoracic surgery (VATS) for right non-small cell lung cancer (NSCLC) radical resection, which functionally dissected the lymph nodes of station 2R/4R/7.

Methods: A retrospective study was performed in the clinical data of 196 patients with VATS right NSCLC radical resection. According to the different methods of lymph node dissection of station 2R, 4R and 7, they were divided into the tunnel-type group (n=102) and the routine group (n=94). The clinical data of two group were compared.

Results: The analyses of the baselines of the two groups are comparable. For lymph nodes dissection of station 2R/4R/7, operation time, the total number, positive number and metastasis incidence shown no significant difference between two groups (P>0.05). However, the amount of bleeding, postoperative thoracic drainage volume, extubation time, hospitalization days, the incidence of postoperative pulmonary infection and chronic cough were significantly lower in the tunnel-type group (P<0.05). There was no significant difference in 3-year recurrence and metastasis and in 3-year survival between tunnel-type group and routine group.

Conclusions: The tunnel-type group has more advantages, such as less surgical trauma, shorter hospitalization time, faster postoperative rehabilitation, even less postoperative chronic cough compared with the routine group. Therefore, we believe that the tunnel-type en bloc mediastinal lymph node dissection is a safe, thorough and feasible surgical method, which is worthy of being popularized and applied in the VATS right NSCLC radical resection.

Keywords: Right lung cancer; functional lymph node dissection; tunnel-type; vagus nerve pulmonary branches.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Tunnel-type en bloc mediastinal lymph node dissection in video-assisted thoracic surgery right non-small cell lung cancer radical resection (14). Available online: http://www.asvide.com/article/view/30110

Figure 2

The difference between tunnel-type group and routine group in the mediastinal lymph node dissection. (A) Routine lymph node dissection of station 2R/4R; (B) routine lymph node dissection of station 7; (C) tunnel-type lymph node dissection of station 2R/4R; (D) tunnel-type lymph node dissection of station 7. AV, azygos vein; Tr, trachea; SVC, subclavian vein; ESO, esophagus; LMB, left main bronchus; RMB, right main bronchus; VN, vagus nerve; yellow dashed line in (A) shows vagus nerve and pulmonary vagus nerve branches.

Figure 3

There was no significant difference in 3-year survival, recurrence and metastasis by log-rank test between the groups. (A) Recurrence curves of patients between tunnel-type group and routine group; (B) survival curves of patients between tunnel-type group and routine group.