Clinical Research Of Intrapulmonary Lymph Node Dissection For Non-small Cell Lung Cancer (Report Of 234 Cases)

Background and ObjectiveStandard lymph node(LN)dissection is of significance in resection of non-small cell lung cancer(NSCLC).In accordance with the recommendations of UICC and AJCC,lymph nodes in NSCLC can be divided into first station(N1)and second station(N2),in which N1 include hilar LN(No10),interlobar LN(No11),lobar bronchial LN(No12),segmental bronchial LN(No13)and sub-segmental bronchial LN(No14).Lymph nodes in No.13 and No.14 groups are also called as the intrapulmonary lymph node(ILN).In clinical practice,thoracic surgeons usually ignore the dissection and submission of ILN.Thus,the study aims to investigate the clinical value of standard dissection of ILN in resection of NSCLC.MethodA total of 234 primary peripheral NSCLC patents who consecutively underwent the radical operation by the same operative team in the department of thoracic surgery in the First Affiliated Hospital of CQMU were enrolled between January 2013 and December 2015.After the resection of affected lobes,the intrapulmonary LNs along the bronchial tree in the associated regions(i.e.No12,No13 and No14)were excised,labeled and preserved in separated bags and submitted for pathological examinations.In the surgery,systemic dissection was also performed for the mediastinal LNs.ResultsA total of 3019 first station LNs were dissected(12.90/case),in which there were 263 metastatic LNs with a metastasis rate of 8.71%.Eleven patients were classified as skip metastasis N2(4.70%).The results of conventional pathological examination showed that a total of 135 patients(57.69%)without N2 or N1 metastasis.Metastasis in No13 and/or No14 was detected in 16 patients(6.84%).Among the N1 positive patients,the positive rate of No10,No11,No12,No13 and No14 metastasis was 2.69%,10.51%,9.83%,10.43% and 8.48%,respectively.Misdiagnositic rate of N1 metastasis would be 6.84%(16/234)if the No13 and No14 were not ignored.ConclusionStandard dissection of ILNs during surgery is of great significance for the accurate staging plans and the selection of postoperative adjuvant treatment plans for patients with NSCLC.