Lung cancer occupies leading positions in the structure of cancer morbidity and mortality. The exclusion of metastatic intrathoracic lymph nodes when staging primary non-small-cell lung cancer (NSCLC) plays an important role in terms of prognosis and determination of further treatment policy.
OBJECTIVE
To analyze the immediate results and clinical efficacy of mediastinal staging of resectable lung cancer, by using mediastinoscopy and video-assisted mediastinal lymphadenectomy (VAMLA).
MATERIAL AND METHODS
In August 2020 to December 2021, the immediate results of mediastinoscopy and VAMLA were retrospectively analyzed in 15 and 45 patients, respectively. The median age was 63 years (58; 69 years); (the age group aged 42 to 77 years); there was a male preponderance (55:5). Central cancer was detected in 24 (40%) patients. The primary tumor size varied from 8 to 107 mm with a median of 45 (32; 72) mm.
RESULTS
The median number of resected lymph nodes was 14.5 (10; 20) in the VAMLA group. Metastatic intrathoracic lymph nodes were confirmed in 20 (33.3%) of the 60 cases (95% CI 22.7-45.9%) with the affected N2, N3, and N1 collectors in 16 (26.7%), 3 (5%), and 1 (1.7%) patients, respectively. The disease stage after invasive staging and before treatment was changed in 26 (43.3%) of the 60 patients (95% CI 31.6-55.9%), with an increase or decrease in 8 (13.3%) (95% CI 6.9-24.2%) and 18 (30%) patients (95% CI 19.9-42.5%), respectively. After staging surgery, surgical treatment, chemotherapy, and chemoradiotherapy were used in 27 (45%), 31 (51.7%) and 2 (3.3%) patients, respectively. Surgical treatment was performed in 27 cases at the first stage and in 8 patients after neoadjuvant drug therapy.
CONCLUSION
Invasive mediastinal staging plays an important role in assessing the locoregional prevalence of NSCLC, allowing identification of both patients in need of combination treatment and a group of patients with primary overdiagnosis of intrathoracic lymph node involvement who can be offered radical surgical treatment.
