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http://dx.doi.org/10.5090/kjtcs.2020.53.3.104

Nodal Outcomes of Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Clinical Stage I Lung Cancer  

Choi, Jung Suk (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Lee, Jiyun (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Moon, Young Kyu (Department of Thoracic and Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Moon, Seok Whan (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Park, Jae Kil (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Moon, Mi Hyoung (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
Publication Information
Journal of Chest Surgery / v.53, no.3, 2020 , pp. 104-113 More about this Journal
Abstract
Background: Accurate intraoperative assessment of mediastinal lymph nodes is a critical aspect of lung cancer surgery. The efficacy and potential for upstaging implicit in these dissections must therefore be revisited in the current era of uniportal video-assisted thoracoscopic surgery (VATS). Methods: A retrospective study was conducted in which 544 patients with stage I (T1abc-T2a, N0, M0) primary lung cancer were analyzed. To assess risk factors for nodal upstaging and to limit any imbalance imposed by surgical choices, we constructed an inverse probability of treatment-weighted (IPTW) logistic regression model (in addition to non-weighted logistic models). We also evaluated risk factors for early locoregional recurrence using IPTW logistic regression analysis. Results: In the comparison of uniportal and multiportal VATS, the resected lymph node count (14.03±8.02 vs. 14.41±7.41, respectively; p=0.48) and rate of nodal upstaging (6.5% vs. 8.7%, respectively; p=0.51) appeared similar. Predictors of nodal upstaging included tumor size (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.12-2.70), carcinoembryonic antigen level (OR, 1.11; 95% CI, 1.04-1.18), and histologically confirmed pleural invasion (OR, 3.97; 95% CI, 1.89-8.34). The risk factors for locoregional recurrence within 1 year were found to be number of resected N2 nodes, age, and nodal upstaging. Conclusion: Uniportal and multiportal VATS appear similar with regard to accuracy and thoroughness, showing no significant difference in the extent of nodal dissection.
Keywords
Lung neoplasms; Nodal upstaging; Single port video-assisted thoracic surgery; Uniportal; Video-assisted thoracic surgery;
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1 National Comprehensive Cancer Network. Non-small cell lung cancer: version 5 [Internet]. Plymouth Meeting (PA): National Comprehensive Cancer Network; 2019 [cited 2019 Jul 22]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf.
2 Lin J, Fernandez F. Indications for invasive mediastinal staging for non-small cell lung cancer. J Thorac Cardiovasc Surg 2018;156:2319-24.   DOI
3 Turner SR, Seyednejad N, Nasir BS. Patterns of practice in mediastinal lymph node staging for non-small cell lung cancer in Canada. Ann Thorac Surg 2018;106:428-34.   DOI
4 Wang Y, Darling GE. Complete mediastinal lymph node dissection versus systematic lymph node sampling in surgical treatment of nonsmall cell lung cancer: do we have the answer? J Thorac Dis 2017;9:4169-70.   DOI
5 Lardinois D, De Leyn P, van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg 2006;30:787-92.   DOI
6 Goldstraw P. Report on the international workshop on intrathoracic staging: London, October 1996. Lung Cancer 1997;18:107-11.   DOI
7 Lewis RJ. The role of video-assisted thoracic surgery for carcinoma of the lung: wedge resection to lobectomy by simultaneous individual stapling. Ann Thorac Surg 1993;56:762-8.   DOI
8 Gonzalez-Rivas D, de la Torre M, Fernandez R, Mosquera VX. Single-port video-assisted thoracoscopic left upper lobectomy. Interact Cardiovasc Thorac Surg 2011;13:539-41.   DOI
9 Wang BY, Tu CC, Liu CY, Shih CS, Liu CC. Single-incision thoracoscopic lobectomy and segmentectomy with radical lymph node dissection. Ann Thorac Surg 2013;96:977-82.   DOI
10 Liu CC, Shih CS, Pennarun N, Cheng CT. Transition from a multiport technique to a single-port technique for lung cancer surgery: is lymph node dissection inferior using the single-port technique? Eur J Cardiothorac Surg 2016;49 Suppl 1:i64-72.
11 Mu JW, Gao SG, Xue Q, et al. A propensity matched comparison of effects between video assisted thoracoscopic single-port, two-port and three-port pulmonary resection on lung cancer. J Thorac Dis 2016;8:1469-76.   DOI
12 Taylor MD, Nagji AS, Bhamidipati CM, et al. Tumor recurrence after complete resection for non-small cell lung cancer. Ann Thorac Surg 2012;93:1813-20.   DOI
13 Fedor D, Johnson WR, Singhal S. Local recurrence following lung cancer surgery: incidence, risk factors, and outcomes. Surg Oncol 2013;22:156-61.   DOI
14 Lee J, Lee JY, Choi JS, Sung SW. Comparison of uniportal versus multiportal video-assisted thoracoscopic surgery pulmonary segmentectomy. Korean J Thorac Cardiovasc Surg 2019;52:141-7.   DOI
15 McCaffrey DF, Griffin BA, Almirall D, Slaughter ME, Ramchand R, Burgette LF. A tutorial on propensity score estimation for multiple treatments using generalized boosted models. Stat Med 2013;32:3388-414.   DOI
16 Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg 2004;77:726-8.   DOI
17 Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies: version 2. Stat Med 2015;34:3661-79.   DOI
18 Austin PC. The performance of different propensity score methods for estimating marginal hazard ratios. Stat Med 2013;32:2837-49.   DOI
19 Hirai K, Takeuchi S, Usuda J. Single-port video-assisted thoracic surgery for early lung cancer: initial experience in Japan. J Thorac Dis 2016;8(Suppl 3):S344-50.
20 Heo W, Kang DK, Min HK, Jun HJ, Hwang YH. Feasibility and safety of single-port video-assisted thoracic surgery for primary lung cancer. Korean J Thorac Cardiovasc Surg 2017;50:190-6.   DOI
21 Delgado Roel M, Fieira Costa EM, Gonzalez-Rivas D, Fernandez LM, Fernandez Prado R, de la Torre M. Uniportal video-assisted thoracoscopic lymph node dissection. J Thorac Dis 2014;6(Suppl 6):S665-8.
22 Gonzalez-Rivas D, Paradela M, Fernandez R, et al. Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Ann Thorac Surg 2013;95:426-32.   DOI
23 Toker A, Ozyurtkan MO, Kaba E. Nodal upstaging: effects of instrumentation and three-dimensional view in clinical stage I lung cancer. J Vis Surg 2017;3:76.   DOI
24 D'Cunha J, Herndon JE 2nd, Herzan DL, et al. Poor correspondence between clinical and pathologic staging in stage 1 non-small cell lung cancer: results from CALGB 9761, a prospective trial. Lung Cancer 2005;48:241-6.   DOI
25 Koike T, Koike T, Yamato Y, Yoshiya K, Toyabe S. Predictive risk factors for mediastinal lymph node metastasis in clinical stage IA non-small-cell lung cancer patients. J Thorac Oncol 2012;7:1246-51.   DOI
26 Bertani A, Gonfiotti A, Nosotti M, et al. Nodal management and upstaging of disease: initial results from the Italian VATS Lobectomy Registry. J Thorac Dis 2017;9:2061-70.   DOI
27 Tantraworasin A, Saeteng S, Siwachat S, et al. Impact of lymph node management on resectable non-small cell lung cancer patients. J Thorac Dis 2017;9:666-74.   DOI
28 Bao F, Yuan P, Yuan X, Lv X, Wang Z, Hu J. Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer. J Thorac Dis 2014;6:1697-703.   DOI