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OBJECTIVE: To identify stage migration in patients with Non Small Cell Lung Cancer (NSCLC) operated by VATS Major Pulmonary Resection (VMPR) and Systematic Nodal Dissection (SND) if they were to receive Lobe Specific Nodal Dissection (LSND) instead
METHODS: Patients undergoing first time VMPR + SND for NSCLC with a negative mediastinum on CT and PET. SND was defined as at least 2 nodes from at least 3 stations including subcarinal #7, and 90% of patients had at least 10 nodes harvested. LSND was defines as at least 6 nodes in total, harvesting for Right Upper Lobe or Right Middle Lobe: 2R, 4R and 7, for Right lower lobe: 4R, 7,8,9, for Left Upper Lobe: 5,6,7 and for Left Lower Lobe 7,8,9. Cancer staging was recalculated for patients who underwent SND, excluding nodes harvested in excess of LSND. Stage migration is the main outcome of this study
RESULTS: Between April 2005 and March 2011, 101 consecutive patients met the criteria. 98.9% of these patients had six or more nodes harvested from three stations and always including #7. Median number of harvested nodes (right = 12, range 5_33; left = 10, range 7_21. Recalculating the pathological staging after disregard to nodes beyond LSND did not change the staging in a single station. SND failed to migrate the staging from LSND
CONCLUSIONS: There is strong evidence that evaluating mediastinal N2 node by LSND is as good as SND. It follows that N2 metastases are predictable and can be covered by LSND without compromise to staging