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Sampling versus systematic full lymphatic dissection in surgical treatment of non-small cell lung cancer

Georgios Koulaxouzidis, Grigorios Karagkiouzis, Marios Konstantinou, Ioannis Gkiozos, Konstantinos Syrigos
  • Georgios Koulaxouzidis
    2nd Thoracic Surgery Department, Sotiria General Hospital, Athens, Greece
  • Grigorios Karagkiouzis
    2nd Thoracic Surgery Department, Sotiria General Hospital, Athens, Greece
  • Marios Konstantinou
    2nd Thoracic Surgery Department, Sotiria General Hospital, Athens, Greece
  • Ioannis Gkiozos
    Oncology Unit GPP, Sotiria General Hospital, Athens, Greece
  • Konstantinos Syrigos
    Oncology Unit GPP, Sotiria General Hospital, Athens, Greece; Thoracic Oncology, Yale School of Medicine, New Haven, CT, USA, | ksyrigos@med.uoa.gr

Abstract

The extent of mediastinal lymph node assessment during surgery for non-small cell cancer remains controversial. Different techniques are used, ranging from simple visual inspection of the unopened mediastinum to an extended bilateral lymph node dissection. Furthermore, different terms are used to define these techniques. Sampling is the removal of one or more lymph nodes under the guidance of pre-operative findings. Systematic (full) nodal dissection is the removal of all mediastinal tissue containing the lymph nodes systematically within anatomical landmarks. A Medline search was conducted to identify articles in the English language that addressed the role of mediastinal lymph node resection in the treatment of non-small cell lung cancer. Opinions as to the reasons for favoring full lymphatic dissection include complete resection, improved nodal staging and better local control due to resection of undetected micrometastasis. Arguments against routine full lymphatic dissection are increased morbidity, increase in operative time, and lack of evidence of improved survival. For complete resection of non-small cell lung cancer, many authors recommend a systematic nodal dissection as the standard approach during surgery, and suggest that this provides both adequate nodal staging and guarantees complete resection. Whether extending the lymph node dissection influences survival or recurrence rate is still not known. There are valid arguments in favor in terms not only of an improved local control but also of an improved long-term survival. However, the impact of lymph node dissection on long-term survival should be further assessed by large-scale multicenter randomized trials.

Keywords

non-small cell lung cancer, surgery, complete resection, systematic lymph node dissection, sampling.

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Submitted: 2013-03-25 21:57:12
Published: 2013-06-18 14:46:07
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Copyright (c) 2013 Georgios Koulaxouzidis, Grigorios Karagkiouzis, Marios Konstantinou, Ioannis Gkiozos, Konstantinos Syrigos

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