| Background and Objectives:Lymph node metastasis is one of the most important approach of metastases of non-small cell lung cancer(NSCLC).Through Dissection of regional lymph nodes during operation will be helpful for accurate staging after operation,and for improving local control rate as well as facilitating the implementation of postoperative comprehensive treatment.The purpose of this study was to explore the feasibility,safety and clinical significance of extended lower paratracheal(4L)lymph node dissection of patients undergoing central lung cancer resection through open approach.Methods:A retrospective study was performed for 217 patients with central non-small cell lung cancer who underwent radical open approach resection in the same surgery group at the first affiliated hospital of Chongqing Medical University from 2015 to 2019.According to whether or not an extended lower paratracheal lymph node dissection was performed on thecontralateral side,the patients were divided into extended dissection group(ESND,performed with extended lower paratracheal lymph node dissection,n=95)and systematic dissection group(SND,performed with systematic lymph node dissection,n=122).The operative time,volume of intraoperative blood loss,time of postoperative chest drainage,the amount of thoracic drainage,time of postoperative hospital stay and postoperative complication rate were compared.Results:There was no difference in basic clinical parameters including age(p=0.371),gender(p=0.773),body mass index(p=0.838)between two groups.The difference regarding the operation time(p=0.538),volume of intraoperative blood loss(p=0.530),time of chest drainage(p=0.503),amount of postoperative chest drainage on the first day(p=0.633),total amount of postoperative chest drainage(p=0.321)and postoperative pulmonary infection rate(p=0.667)was not statistically significant between two groups.The postoperative pathological types of ESND group included50 cases of squamous cell carcinoma,27 cases of adenocarcinoma,and 18 cases of other types.The average operative time was 158.65±42.64 minutes,the average amount of intraoperative blood loss was 283.68±118.60 ml,the average postoperative time of thoracic catheter insertion was 6.06±4.01 days,the average volume of postoperative drainage on the first day was261.81±155.46 ml,and the average total postoperative drainage volumewas 1030.67±860.59 ml.The postoperative pathological types of SND group included 68 cases of squamous cell carcinoma,38 cases of adenocarcinoma,and 16 cases of other types.The average operative time was 155.02±43.35 m inutes,the average volume of intraoperative blood loss was 272.79±136.01 ml,the average time of postoperative drainage was5.72±3.48 days,the average volume of postoperative drainage on the first day was 252.54±130.04 ml,and the total voume of postoperative drainage was 937.7±334.58 ml.Among the 95 patients in the ESND group,13 cases of lower paratracheal lymph node metastasis which include 4 cases of squamous cell carcinoma,8 cases of adenocarcinoma and 1 case of large cell lung cancer were found on the contralateral side according to the postoperative pathological biopsy.Among the 13 cases,9 cases were left lung cancer and 4 cases were right lung cancer,respectively.In addition,11 cases were metastatic in both N1 and N2 lymph node,while 2 cases were only N1 lymph node metastasis which is directly skip metastat to the lower paratracheal of contralateral side,with a skip metastatic rate of 15.38%.Conclusion:In the process of central lung cancer resection through open approach,extended lower paratracheal lymph node dissection is helpful to make the operation more radical,which is a safe and feasible method of lymph node dissection with clinical application value.For patients with ipsilateral lower paratracheal lymph node metastasis,the extended lower paratracheal lymphnode dissection should be routinely dissected on contralateral side to improve the operative clinical value. |
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