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A national study of nodal upstaging after thoracoscopic versus open lobectomy for clinical stage I lung cancer.
Ann Thorac Surg. 2013 Sep; 96(3):943-9; discussion 949-50.AT

Abstract

BACKGROUND

Nodal upstaging after surgical intervention for non-small cell lung cancer (NSCLC) occurs when unsuspected lymph node metastases are found during the final evaluation of surgical specimens. Recent data from The Society of Thoracic Surgery (STS) database demonstrated significantly lower nodal upstaging after thoracoscopic (VATS) lobectomy than after thoracotomy. STS data, however, may be biased from voluntary reporting, and survival was not investigated. We used a complete national registry to compare nodal upstaging and survival after lobectomy by VATS or thoracotomy.

METHODS

The Danish Lung Cancer Registry was used to identify patients who underwent lobectomy for clinical stage I NSCLC from 2007 to 2011. Patient demographics, comorbidity, preoperative staging, surgical approach, number of lymph nodes harvested, final pathology, and survival were evaluated. Nodal upstaging was identified by comparing cT N M with pT N M.

RESULTS

Lobectomy for clinical stage I NSCLC was performed in 1,513 patients: 717 (47%) by VATS and 796 (53%) by thoracotomy. Nodal upstaging occurred in 281 patients (18.6%) and was significantly higher after thoracotomy for N1 upstaging (13.1% vs 8.1%; p<0.001) and N2 upstaging (11.5% vs 3.8%; p<0.001). Overall unadjusted survival was significantly higher after VATS, but after adjusting for differences in sex, age, comorbidity, and pT N M by Cox regression analysis, we found no difference between VATS and thoracotomy (hazard ratio, 0.98; 95% confidence interval, 0.80 to 1.22, p=0.88).

CONCLUSIONS

National data confirm that nodal upstaging was lower after VATS than after open lobectomy for clinical stage I NSCLC. Multivariate survival analysis, however, showed no difference in survival, indicating that differences in nodal upstaging result from patient selection for reasons not captured in our registry.

Authors+Show Affiliations

Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark. plicht@health.sdu.dkNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23684159

Citation

Licht, Peter B., et al. "A National Study of Nodal Upstaging After Thoracoscopic Versus Open Lobectomy for Clinical Stage I Lung Cancer." The Annals of Thoracic Surgery, vol. 96, no. 3, 2013, pp. 943-9; discussion 949-50.
Licht PB, Jørgensen OD, Ladegaard L, et al. A national study of nodal upstaging after thoracoscopic versus open lobectomy for clinical stage I lung cancer. Ann Thorac Surg. 2013;96(3):943-9; discussion 949-50.
Licht, P. B., Jørgensen, O. D., Ladegaard, L., & Jakobsen, E. (2013). A national study of nodal upstaging after thoracoscopic versus open lobectomy for clinical stage I lung cancer. The Annals of Thoracic Surgery, 96(3), 943-9; discussion 949-50. https://doi.org/10.1016/j.athoracsur.2013.04.011
Licht PB, et al. A National Study of Nodal Upstaging After Thoracoscopic Versus Open Lobectomy for Clinical Stage I Lung Cancer. Ann Thorac Surg. 2013;96(3):943-9; discussion 949-50. PubMed PMID: 23684159.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A national study of nodal upstaging after thoracoscopic versus open lobectomy for clinical stage I lung cancer. AU - Licht,Peter B, AU - Jørgensen,Ole Dan, AU - Ladegaard,Lars, AU - Jakobsen,Erik, Y1 - 2013/05/16/ PY - 2013/01/30/received PY - 2013/03/29/revised PY - 2013/04/02/accepted PY - 2013/5/21/entrez PY - 2013/5/21/pubmed PY - 2013/11/15/medline KW - 10 SP - 943-9; discussion 949-50 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 96 IS - 3 N2 - BACKGROUND: Nodal upstaging after surgical intervention for non-small cell lung cancer (NSCLC) occurs when unsuspected lymph node metastases are found during the final evaluation of surgical specimens. Recent data from The Society of Thoracic Surgery (STS) database demonstrated significantly lower nodal upstaging after thoracoscopic (VATS) lobectomy than after thoracotomy. STS data, however, may be biased from voluntary reporting, and survival was not investigated. We used a complete national registry to compare nodal upstaging and survival after lobectomy by VATS or thoracotomy. METHODS: The Danish Lung Cancer Registry was used to identify patients who underwent lobectomy for clinical stage I NSCLC from 2007 to 2011. Patient demographics, comorbidity, preoperative staging, surgical approach, number of lymph nodes harvested, final pathology, and survival were evaluated. Nodal upstaging was identified by comparing cT N M with pT N M. RESULTS: Lobectomy for clinical stage I NSCLC was performed in 1,513 patients: 717 (47%) by VATS and 796 (53%) by thoracotomy. Nodal upstaging occurred in 281 patients (18.6%) and was significantly higher after thoracotomy for N1 upstaging (13.1% vs 8.1%; p<0.001) and N2 upstaging (11.5% vs 3.8%; p<0.001). Overall unadjusted survival was significantly higher after VATS, but after adjusting for differences in sex, age, comorbidity, and pT N M by Cox regression analysis, we found no difference between VATS and thoracotomy (hazard ratio, 0.98; 95% confidence interval, 0.80 to 1.22, p=0.88). CONCLUSIONS: National data confirm that nodal upstaging was lower after VATS than after open lobectomy for clinical stage I NSCLC. Multivariate survival analysis, however, showed no difference in survival, indicating that differences in nodal upstaging result from patient selection for reasons not captured in our registry. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/23684159/A_national_study_of_nodal_upstaging_after_thoracoscopic_versus_open_lobectomy_for_clinical_stage_I_lung_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(13)00743-1 DB - PRIME DP - Unbound Medicine ER -