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Akciğer kanseri rezeksiyonunda tek istasyon N2 tespit edilmiş hastalarda cerrahi tedavi sonuçları

Year 2018, Volume: 4 Issue: 1, 1 - 11, 03.04.2018

Abstract

Amaç: Bu çalışmada, “tesadüfi N2” hastalarının ameliyat öncesinde neden tespit edilmediği ve hangi “tesadüfi N2” hastalarının sağkalımının daha iyi olduğu araştırıldı.

Hastalar ve yöntemler: İstanbul Üniversitesi İstanbul Tıp Fakültesi Göğüs Cerrahisi Anabilim Dalında Ocak 2001-Kasım 2008 tarihleri arasında primer akciğer kanseri nedeni ile ameliyat edilen 597 hastadan tek istasyon mediastinal “tesadüfi N2” lenf nodu metastazı tespit edilen 32 hasta (26 erkek, 6 kadın; ort. yaş 63.5 yıl; dağılım, 30-77 yıl) çalışmaya dahil edildi. Hastalar metastatik lenf nodu istasyonlarına göre üç gruba ayrıldı: Grup 1: Aortikopulmoner (5 ve 6 numaralı) lenf nodlarında metastaz tespit edilmiş hastalar (n=5; %15.6), grup 2: İnferior mediastinal (7, 8 ve 9 numaralı) lenf nodlarında metastaz tespit edilmiş hastalar (n=18; %56.2), grup 3: Süperior mediastinal (2 ve 4 numaralı) lenf nodlarında metastaz tespit edilmiş hastalar (n=9; %28.2).

Bulgular: Tüm hastalar ve gruplar için sağkalım ve hastalıksız sağkalım sürelerini etkileyen faktörler ayrı ayrı analiz edildi. Tüm hastalarda iki ve beş yıllık genel sağkalım oranları sırasıyla ortalama %50.0 ve %29 idi. Beş yıllık genel sağkalım oranı ve hastalıksız sağkalım oranı grup 1, 2 ve 3’te sırasıyla %40.0-%40.0, %33.3-%44.4 ve %22.2-%28.6 idi. Rezeke edilen lenf nodu sayısı ile metastatik lenf nodu sayısı arasında pozitif ve istatistiksel olarak anlamlı bir ilişki tespit edildi.

Sonuç: Çalışmamızda tesadüfi N2 oranı %5.3 idi. Böylece, doğru mediastinal diseksiyon yöntemleri ile gerçek patolojik evrelendirme yapılabildi. Bunun sonucunda, hastanın N durumu açısından doğru evrelendirilmesi ile sağkalım süresini artırmak için hastaya uygun adjuvan onkolojik tedavi sağlandı. Bu nedenle, doğru ameliyat sırası mediastinal evrelendirmenin önemini vurgulamaktayız.

References

  • 1. Klastersky J, Burkes R, Choi N, Dombernowsky P, Darwish S, Ginsberg RJ, et al. Induction therapy for NSCLC: a consensus report. Lung Cancer 1991;7:15-7.
  • 2. Mountain CF. A new international staging system for lung cancer. Chest 1986;89:225-33.
  • 3. Tisi GM, Friedman PJ, Peters RM, Pearson G, Carr D, Lee. RE, et aI. Clinical staging of primary lung cancer: official statement of the American Thoracic Society. Am Rev Respir Dis 1983;127:659-64.
  • 4. Brega Massone PP, Conti B, Magnani B, Lequaglie C, Cataldo I. Video-assisted thoracoscopic surgery for diagnosis, staging, and management of lung cancer with suspected mediastinal lymphadenopathy. Surg Laparosc Endosc Percutan Tech 2002;12:104-9.
  • 5. Naruke T, Suemasu K, Ishikawa S. Surgical treatment for lung cancer with metastasis to mediastinal lymph nodes. J Thorac Cardiovasc Surg 1976;71:279-85.
  • 6. Izbicki JR, Passlick B, Pantel K, Pichlmeier U, Hosch SB, Karg O, et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg 1998;227:138-44.
  • 7. Cerfolio RJ, Bryant AS, Eloubeidi MA. Routine mediastinoscopy and esophageal ultrasound fine-needle aspiration in patients with non-small cell lung cancer who are clinically N2 negative: a prospective study. Chest 2006;130:1791-5.
  • 8. Al-Sarraf N, Aziz R, Gately K, Lucey J, Wilson L, McGovern E, et al. Pattern and predictors of occult mediastinal lymph node involvement in non-small cell lung cancer patients with negative mediastinal uptake on positron emission tomography. Eur J Cardiothorac Surg 2008;33:104-9.
  • 9. Goldstraw P. The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer. Thorax 1992;47:1-2.
  • 10. Gaer JA, Goldstraw P. Intraoperative assessment of nodal staging at thoracotomy for carcinoma of the bronchus. Eur J Cardiothorac Surg 1990;4:207-10.
  • 11. Cerfolio RJ, Maniscalco L, Bryant AS. The treatment of patients with stage IIIA non-small cell lung cancer from N2 disease: who returns to the surgical arena and who survives. Ann Thorac Surg 2008;86:912-20.
  • 12. Asamura H, Suzuki K, Kondo H, Tsuchiya R. Where is the boundary between N1 and N2 stations in lung cancer? Ann Thorac Surg 2000;70:1839-45.
  • 13. Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg 1978;76:832-9.
  • 14. Ohta Y, Shimizu Y, Minato H, Matsumoto I, Oda M, Watanabe G. Results of initial operations in non-small cell lung cancer patients with single-level N2 disease. Ann Thorac Surg 2006;81:427-33.
  • 15. Cerfolio RJ, Bryant AS. Survival of patients with unsuspected N2 (stage IIIA) nonsmall-cell lung cancer. Ann Thorac Surg 2008;86:362-6.
  • 16. Pearson FG, DeLarue NC, Ilves R, Todd TR, Cooper JD. Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J Thorac Cardiovasc Surg 1982;83:1-11.
  • 17. Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H. Prognosis of completely resected pN2 non-small cell lung carcinomas: What is the significant node that affects survival? J Thorac Cardiovasc Surg 1999;118:270-5.
  • 18. Keller SM, Vangel MG, Wagner H, Schiller JH, Herskovic A, Komaki R, et al. Prolonged survival in patients with resected non-small cell lung cancer and single-level N2 disease. J Thorac Cardiovasc Surg 2004;128:130-7.
  • 19. Thomas PA, Piantadosi S, Mountain CF. Should subcarinal lymph nodes be routinely examined in patients with non-small cell lung cancer? The Lung Cancer Study Group. J Thorac Cardiovasc Surg 1988;95:883-7.
  • 20. Defranchi SA, Cassivi SD, Nichols FC, Allen MS, Shen KR, Deschamps C, et al. N2 disease in T1 non-small cell lung cancer. Ann Thorac Surg 2009;88:924-8.
  • 21. Watanabe S, Oda M, Go T, Tsunezuka Y, Ohta Y, Watanabe Y, et al. Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized (2 cm or less) lung cancer? Retrospective analysis of 225 patients. Eur J Cardiothorac Surg 2001;20:1007-11.
  • 22. Ueda K, Kaneda Y, Saeki K, Fujita N, Zempo N, Esato K. Hilar lymph nodes in N2 disease: survival analysis of patients with non-small cell lung cancers and regional lymph node metastasis. Surg Today 2002;32:300-4.
Year 2018, Volume: 4 Issue: 1, 1 - 11, 03.04.2018

Abstract

References

  • 1. Klastersky J, Burkes R, Choi N, Dombernowsky P, Darwish S, Ginsberg RJ, et al. Induction therapy for NSCLC: a consensus report. Lung Cancer 1991;7:15-7.
  • 2. Mountain CF. A new international staging system for lung cancer. Chest 1986;89:225-33.
  • 3. Tisi GM, Friedman PJ, Peters RM, Pearson G, Carr D, Lee. RE, et aI. Clinical staging of primary lung cancer: official statement of the American Thoracic Society. Am Rev Respir Dis 1983;127:659-64.
  • 4. Brega Massone PP, Conti B, Magnani B, Lequaglie C, Cataldo I. Video-assisted thoracoscopic surgery for diagnosis, staging, and management of lung cancer with suspected mediastinal lymphadenopathy. Surg Laparosc Endosc Percutan Tech 2002;12:104-9.
  • 5. Naruke T, Suemasu K, Ishikawa S. Surgical treatment for lung cancer with metastasis to mediastinal lymph nodes. J Thorac Cardiovasc Surg 1976;71:279-85.
  • 6. Izbicki JR, Passlick B, Pantel K, Pichlmeier U, Hosch SB, Karg O, et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg 1998;227:138-44.
  • 7. Cerfolio RJ, Bryant AS, Eloubeidi MA. Routine mediastinoscopy and esophageal ultrasound fine-needle aspiration in patients with non-small cell lung cancer who are clinically N2 negative: a prospective study. Chest 2006;130:1791-5.
  • 8. Al-Sarraf N, Aziz R, Gately K, Lucey J, Wilson L, McGovern E, et al. Pattern and predictors of occult mediastinal lymph node involvement in non-small cell lung cancer patients with negative mediastinal uptake on positron emission tomography. Eur J Cardiothorac Surg 2008;33:104-9.
  • 9. Goldstraw P. The practice of cardiothoracic surgeons in the perioperative staging of non-small cell lung cancer. Thorax 1992;47:1-2.
  • 10. Gaer JA, Goldstraw P. Intraoperative assessment of nodal staging at thoracotomy for carcinoma of the bronchus. Eur J Cardiothorac Surg 1990;4:207-10.
  • 11. Cerfolio RJ, Maniscalco L, Bryant AS. The treatment of patients with stage IIIA non-small cell lung cancer from N2 disease: who returns to the surgical arena and who survives. Ann Thorac Surg 2008;86:912-20.
  • 12. Asamura H, Suzuki K, Kondo H, Tsuchiya R. Where is the boundary between N1 and N2 stations in lung cancer? Ann Thorac Surg 2000;70:1839-45.
  • 13. Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg 1978;76:832-9.
  • 14. Ohta Y, Shimizu Y, Minato H, Matsumoto I, Oda M, Watanabe G. Results of initial operations in non-small cell lung cancer patients with single-level N2 disease. Ann Thorac Surg 2006;81:427-33.
  • 15. Cerfolio RJ, Bryant AS. Survival of patients with unsuspected N2 (stage IIIA) nonsmall-cell lung cancer. Ann Thorac Surg 2008;86:362-6.
  • 16. Pearson FG, DeLarue NC, Ilves R, Todd TR, Cooper JD. Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J Thorac Cardiovasc Surg 1982;83:1-11.
  • 17. Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H. Prognosis of completely resected pN2 non-small cell lung carcinomas: What is the significant node that affects survival? J Thorac Cardiovasc Surg 1999;118:270-5.
  • 18. Keller SM, Vangel MG, Wagner H, Schiller JH, Herskovic A, Komaki R, et al. Prolonged survival in patients with resected non-small cell lung cancer and single-level N2 disease. J Thorac Cardiovasc Surg 2004;128:130-7.
  • 19. Thomas PA, Piantadosi S, Mountain CF. Should subcarinal lymph nodes be routinely examined in patients with non-small cell lung cancer? The Lung Cancer Study Group. J Thorac Cardiovasc Surg 1988;95:883-7.
  • 20. Defranchi SA, Cassivi SD, Nichols FC, Allen MS, Shen KR, Deschamps C, et al. N2 disease in T1 non-small cell lung cancer. Ann Thorac Surg 2009;88:924-8.
  • 21. Watanabe S, Oda M, Go T, Tsunezuka Y, Ohta Y, Watanabe Y, et al. Should mediastinal nodal dissection be routinely undertaken in patients with peripheral small-sized (2 cm or less) lung cancer? Retrospective analysis of 225 patients. Eur J Cardiothorac Surg 2001;20:1007-11.
  • 22. Ueda K, Kaneda Y, Saeki K, Fujita N, Zempo N, Esato K. Hilar lymph nodes in N2 disease: survival analysis of patients with non-small cell lung cancers and regional lymph node metastasis. Surg Today 2002;32:300-4.
There are 22 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

Erkan Kaba 0000-0002-0793-8152

Berker Özkan This is me

Serhan Tanju This is me

Şükrü Dilege This is me

Alper Toker This is me

Publication Date April 3, 2018
Published in Issue Year 2018 Volume: 4 Issue: 1

Cite

APA Kaba, E., Özkan, B., Tanju, S., Dilege, Ş., et al. (2018). Akciğer kanseri rezeksiyonunda tek istasyon N2 tespit edilmiş hastalarda cerrahi tedavi sonuçları. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi, 4(1), 1-11.
AMA Kaba E, Özkan B, Tanju S, Dilege Ş, Toker A. Akciğer kanseri rezeksiyonunda tek istasyon N2 tespit edilmiş hastalarda cerrahi tedavi sonuçları. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi. April 2018;4(1):1-11.
Chicago Kaba, Erkan, Berker Özkan, Serhan Tanju, Şükrü Dilege, and Alper Toker. “Akciğer Kanseri Rezeksiyonunda Tek Istasyon N2 Tespit Edilmiş Hastalarda Cerrahi Tedavi sonuçları”. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi 4, no. 1 (April 2018): 1-11.
EndNote Kaba E, Özkan B, Tanju S, Dilege Ş, Toker A (April 1, 2018) Akciğer kanseri rezeksiyonunda tek istasyon N2 tespit edilmiş hastalarda cerrahi tedavi sonuçları. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi 4 1 1–11.
IEEE E. Kaba, B. Özkan, S. Tanju, Ş. Dilege, and A. Toker, “Akciğer kanseri rezeksiyonunda tek istasyon N2 tespit edilmiş hastalarda cerrahi tedavi sonuçları”, İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi, vol. 4, no. 1, pp. 1–11, 2018.
ISNAD Kaba, Erkan et al. “Akciğer Kanseri Rezeksiyonunda Tek Istasyon N2 Tespit Edilmiş Hastalarda Cerrahi Tedavi sonuçları”. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi 4/1 (April 2018), 1-11.
JAMA Kaba E, Özkan B, Tanju S, Dilege Ş, Toker A. Akciğer kanseri rezeksiyonunda tek istasyon N2 tespit edilmiş hastalarda cerrahi tedavi sonuçları. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi. 2018;4:1–11.
MLA Kaba, Erkan et al. “Akciğer Kanseri Rezeksiyonunda Tek Istasyon N2 Tespit Edilmiş Hastalarda Cerrahi Tedavi sonuçları”. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi, vol. 4, no. 1, 2018, pp. 1-11.
Vancouver Kaba E, Özkan B, Tanju S, Dilege Ş, Toker A. Akciğer kanseri rezeksiyonunda tek istasyon N2 tespit edilmiş hastalarda cerrahi tedavi sonuçları. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi. 2018;4(1):1-11.