Radicality of lymphadenectomy in lung cancer resections by thoracotomy and video-assisted thoracoscopic approach: A prospective, multicentre and propensity-score adjusted study
Obiols, Carme ; Call, Sergi ; Rami-Porta, Ramón ; Jaén, Ángeles ; Gómez de Antonio, David ; Crowley Carrasco, Silvana ; Royo-Crespo, Íñigo ; Embún, Raúl (Universidad de Zaragoza)
Resumen: Objective: To analyse differences in intraoperative nodal assessment in patients undergoing lung cancer resection by thoracotomy and video-assisted thoracoscopy (VATS) in the Spanish Video-Assisted Thoracic Surgery Group (GEVATS).
Methods: Prospective multicentre cohort study of anatomic pulmonary resections (n = 3533) performed from December 2016 to March 2018. Main surgical, clinical and oncological variables related with lymphadenectomy were compared according to surgical approach. Corresponding tests for homogeneity were performed. Multiple logistic regression analyses were used to determine the odds ratio (OR) and 95% confidence interval (95%CI). Covariate adjustment using the propensity score (PS) was performed to reduce confounding effects.
Results: After exclusions, 2532 patients were analysed. Systematic nodal dissection (SND) was performed in 65%, with a median of resected/sampled lymph nodes (LN) of 7 (IQR 4–12) and pathologic (p) N2 and uncertain (u) pNu rates of 9.4% and 28.9%, respectively.
At multivariate analysis, the following were associated with thoracotomy (OR; 95%CI): SND (1.4; 1.08–1.96; p = 0.014), staging mediastinoscopy (2.6; 1.59–4.25; p < 0.001), tumor > 3 cm (2.1; 1.66–2.78; p < 0.001), central tumor (2.5; 1.90–3.24; p < 0.001); pN1 (1.8; 1.25–2.67; p < 0.002), pN2 (1.8; 1.18–2.76; p = 0.006), lower FEV1 (0.9; 0.98–0.99; p < 0.001), squamous cell carcinoma (1.5; 1.16–1.98; p = 0.002) and inexperienced surgeons in VATS (compared with > 100 VATS experience) (37.6; 13.55–104.6; p < 0.001). After PS adjustment, SND maintained the OR, but in the limit of signification (1.4; 1–1.98; p = 0.05). Nodal upstaging was significantly higher in the thoracotomy group. Complication rates of SND and no SND were similar.
Conclusions: Thoracotomy was associated with a more thorough lymphadenectomy in GEVATS. Therefore, intraoperative lymph node evaluation performed at VATS should be improved to have better prognostic information and more solid grounds to indicate adjuvant therapy.
Idioma: Inglés
DOI: 10.1016/j.lungcan.2022.01.004
Año: 2022
Publicado en: LUNG CANCER 165 (2022), 63-70
ISSN: 0169-5002
Factor impacto JCR: 5.3 (2022)
Categ. JCR: RESPIRATORY SYSTEM rank: 18 / 66 = 0.273 (2022) - Q2 - T1
Categ. JCR: ONCOLOGY rank: 70 / 241 = 0.29 (2022) - Q2 - T1
Factor impacto CITESCORE: 10.3 - Medicine (Q1) - Biochemistry, Genetics and Molecular Biology (Q1)
Factor impacto SCIMAGO: 1.609 - Cancer Research (Q1) - Pulmonary and Respiratory Medicine (Q1) - Oncology (Q1)
Tipo y forma: Artículo (Versión definitiva)
Área (Departamento): Área Cirugía (Dpto. Cirugía)
Derechos reservados por el editor de la revista
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Exportado de SIDERAL (2025-10-17-14:34:41)
Methods: Prospective multicentre cohort study of anatomic pulmonary resections (n = 3533) performed from December 2016 to March 2018. Main surgical, clinical and oncological variables related with lymphadenectomy were compared according to surgical approach. Corresponding tests for homogeneity were performed. Multiple logistic regression analyses were used to determine the odds ratio (OR) and 95% confidence interval (95%CI). Covariate adjustment using the propensity score (PS) was performed to reduce confounding effects.
Results: After exclusions, 2532 patients were analysed. Systematic nodal dissection (SND) was performed in 65%, with a median of resected/sampled lymph nodes (LN) of 7 (IQR 4–12) and pathologic (p) N2 and uncertain (u) pNu rates of 9.4% and 28.9%, respectively.
At multivariate analysis, the following were associated with thoracotomy (OR; 95%CI): SND (1.4; 1.08–1.96; p = 0.014), staging mediastinoscopy (2.6; 1.59–4.25; p < 0.001), tumor > 3 cm (2.1; 1.66–2.78; p < 0.001), central tumor (2.5; 1.90–3.24; p < 0.001); pN1 (1.8; 1.25–2.67; p < 0.002), pN2 (1.8; 1.18–2.76; p = 0.006), lower FEV1 (0.9; 0.98–0.99; p < 0.001), squamous cell carcinoma (1.5; 1.16–1.98; p = 0.002) and inexperienced surgeons in VATS (compared with > 100 VATS experience) (37.6; 13.55–104.6; p < 0.001). After PS adjustment, SND maintained the OR, but in the limit of signification (1.4; 1–1.98; p = 0.05). Nodal upstaging was significantly higher in the thoracotomy group. Complication rates of SND and no SND were similar.
Conclusions: Thoracotomy was associated with a more thorough lymphadenectomy in GEVATS. Therefore, intraoperative lymph node evaluation performed at VATS should be improved to have better prognostic information and more solid grounds to indicate adjuvant therapy.
Idioma: Inglés
DOI: 10.1016/j.lungcan.2022.01.004
Año: 2022
Publicado en: LUNG CANCER 165 (2022), 63-70
ISSN: 0169-5002
Factor impacto JCR: 5.3 (2022)
Categ. JCR: RESPIRATORY SYSTEM rank: 18 / 66 = 0.273 (2022) - Q2 - T1
Categ. JCR: ONCOLOGY rank: 70 / 241 = 0.29 (2022) - Q2 - T1
Factor impacto CITESCORE: 10.3 - Medicine (Q1) - Biochemistry, Genetics and Molecular Biology (Q1)
Factor impacto SCIMAGO: 1.609 - Cancer Research (Q1) - Pulmonary and Respiratory Medicine (Q1) - Oncology (Q1)
Tipo y forma: Artículo (Versión definitiva)
Área (Departamento): Área Cirugía (Dpto. Cirugía)
Derechos reservados por el editor de la revista0
Exportado de SIDERAL (2025-10-17-14:34:41)
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Registro creado el 2025-09-08, última modificación el 2025-10-17