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Is lower zone mediastinal nodal dissection always mandatory for lung cancer in the lower lobe?

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Abstract

Purpose

Dissection of the lower zone mediastinal nodes is mandatory during systematic nodal dissection for lung cancer. However, the significance of lower zone lymph node metastasis (LZM) in lung cancer remains unclear. Therefore, we aimed to identify the predictive factors for LZM in patients with lower lobe lung cancer.

Methods

A retrospective study was conducted on 257 patients with lower lobe lung cancer, in whom pulmonary resection and mediastinal nodal dissection were performed between 2009 and 2013. The radiological factors on thin-section computed tomography scans (TSCT) and several conventional clinical factors were evaluated as possible predictors of LZM.

Results

Twenty (7.8 %) patients exhibited LZM. The majority of the tumors were especially located in segment 10 (50 %). All patients showed a solid appearance on TSCT. In a univariate analysis, the tumor location, a solid appearance and the clinical T factor significantly predicted LZM (p = 0.011, 0.005, 0.018). Furthermore, based on a multivariate analysis, the tumor location in segment 10 significantly predicted LZM in patients with lower lobe solid lung cancer (p = 0.031).

Conclusion

The appropriate surgical strategy for lower zone lymph node dissection should be selected based on the tumor location and the findings of TSCT, due to the high frequency of LZM (19.6 %), especially in patients with pure solid lung cancer in segment 10.

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Acknowledgments

This study was supported in part by a Grant-in-Aid for Cancer Research from the Ministry of Health, Labour and Welfare of Japan and the Smoking Research Foundation.

Conflict of interest

Kenji Suzuki has no conflicts of interest to declare in association with this article.

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Authors and Affiliations

  1. Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, 113-8431, Tokyo, Japan

    Hiroyasu Ueno, Aritoshi Hattori, Takeshi Matsunaga, Kazuya Takamochi, Shiaki Oh & Kenji Suzuki

Authors
  1. Hiroyasu Ueno
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  2. Aritoshi Hattori
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  3. Takeshi Matsunaga
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  4. Kazuya Takamochi
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  5. Shiaki Oh
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  6. Kenji Suzuki
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Corresponding author

Correspondence to Kenji Suzuki.

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Ueno, H., Hattori, A., Matsunaga, T. et al. Is lower zone mediastinal nodal dissection always mandatory for lung cancer in the lower lobe?. Surg Today 45, 1390–1395 (2015). https://doi.org/10.1007/s00595-014-1105-z

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  • DOI: https://doi.org/10.1007/s00595-014-1105-z

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