| Contributors: |
Bertani, A.; Gonfiotti, A.; Nosotti, M.; Ferrari, P. A.; De Monte, L.; Russo, E.; Di Paola, G.; Solli, P.; Droghetti, A.; Bertolaccini, L.; Crisci, R.; Curcio, C.; Amore, D.; Marulli, G.; Nicotra, S.; De Negri, A.; Maineri, P.; di Rienzo, G.; Lopez, C.; Morelli, A.; Londero, F.; Spaggiari, L.; Gasparri, R.; Baietto, G.; Casadio, C.; Infante, M.; Benato, C.; Alloisio, M.; Bottoni, E.; Cardillo, G.; Carleo, F.; Stella, F.; Dolci, G.; Puma, F.; Vinci, D.; Cavallesco, G.; Maniscalco, P.; Ampollini, L.; Carbognani, P.; Terzi, A.; Viti, A.; Negri, G.; Bandiera, A.; Perkmann, R.; Zaraca, F.; Andreetti, C.; Poggi, C.; Mucilli, F.; Camplese, P.; Luzzi, L.; Ghisalberti, M.; Imperatori, A.; Rotolo, N.; Bortolotti, L.; Rizzardi, G.; Torre, M.; Rinaldo, A.; Sabbatini, A.; Refai, M.; Benvenuti, M. R.; Benetti, D.; Stefani, A.; Natali, P.; Lausi, P.; Guerrera, F. |
| Description: |
Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy. |