Masatsugu Hamaji1, Mitsugu Omasa2, Takao Nakanishi2, Akiyoshi Nakakura3, Satoshi Morita3, Ei Miyamoto4, Tatsuo Nakagawa4, So Miyahara5, Makoto Sonobe6, Mamoru Takahashi7, Yasuji Terada7, Kyoko Hijiya8, Ryota Sumitomo9, Cheng-Long Huang9, Fumitsugu Kojima10, Tsuyoshi Shoji11, Naoki Date12, Ryo Miyata1, Michiharu Suga13, Ryo Nakanobo14, Kenzo Kawakami14, Akihiro Aoyama15, Hiroshi Date1. 1. Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan. 2. Department of Thoracic Surgery, Nishi Kobe Medical Center, Kobe, Japan. 3. Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 4. Department of Thoracic Surgery, Tenri Hospital, Nara, Japan. 5. Department of Thoracic Surgery, Fukuoka University Hospital, Fukuoka, Japan. 6. Department of Thoracic Surgery, Osaka Red Cross Hospital, Osaka, Japan. 7. Department of Thoracic Surgery, Kyoto-Katsura Hospital, Kyoto, Japan. 8. Department of Thoracic Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan. 9. Department of Thoracic Surgery, Kitano Hospital, The Tazuke Kofukai Medical Institute, Osaka, Japan. 10. Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan. 11. Department of Thoracic Surgery, Nagara Medical Center, Gifu, Japan. 12. Department of Thoracic Surgery, Otsu Red Cross Hospital, Osaka, Japan. 13. Department of Thoracic Surgery, Takatsuki Red Cross Hospital, Takatsuki, Japan. 14. Department of Thoracic Surgery, Shiga General Hospital, Shiga, Japan. 15. Department of Thoracic Surgery, Kobe City Medical Centre General Hospital, Kobe, Japan.
Abstract
OBJECTIVES: Although lymph node (LN) metastases are not uncommon in thymic carcinomas, preoperative LN evaluation, intraoperative lymph node dissection (LND) and postoperative outcomes remain unknown. The aim of this study was to elucidate the characteristics of and outcomes in patients with thymic carcinomas and thymic neuroendocrine carcinomas undergoing LND. METHODS: A retrospective chart review was performed using our multi-institutional database to identify patients who underwent resection and LND for thymic carcinoma or thymic neuroendocrine carcinoma between 1991 and 2018. An enlarged mediastinal LN was defined as having a short-axis diameter >1 cm. We assessed survival outcomes using the Kaplan-Meier analysis. RESULTS: N1-level LND was performed in 41 patients (54.6%), N2-level LND in 14 patients (18.7%) and both-level LND in 16 patients (21.3%). Pathological LN metastasis was detected in 20 patients (26.7%) among the 75 patients undergoing LND. There was a significant difference in the number of LN stations (P = 0.015) and metastasis factor (P = 0.0042) between pathologically LN-positive and pathologically LN-negative patients. The sensitivity of enlarged LNs on preoperative computed tomography was 18.2%. There was a tendency towards worse overall survival of pathologically N2-positive patients, although the difference was not statistically significant (P = 0.15). CONCLUSIONS: Preoperative CT appears to play a limited role in detecting pathological LN metastases. Our findings suggest that the significance of N1- and N2-level LND should be evaluated in prospective studies to optimize the postoperative management of patients with thymic carcinomas and neuroendocrine carcinomas.
OBJECTIVES: Although lymph node (LN) metastases are not uncommon in thymic carcinomas, preoperative LN evaluation, intraoperative lymph node dissection (LND) and postoperative outcomes remain unknown. The aim of this study was to elucidate the characteristics of and outcomes in patients with thymic carcinomas and thymic neuroendocrine carcinomas undergoing LND. METHODS: A retrospective chart review was performed using our multi-institutional database to identify patients who underwent resection and LND for thymic carcinoma or thymic neuroendocrine carcinoma between 1991 and 2018. An enlarged mediastinal LN was defined as having a short-axis diameter >1 cm. We assessed survival outcomes using the Kaplan-Meier analysis. RESULTS: N1-level LND was performed in 41 patients (54.6%), N2-level LND in 14 patients (18.7%) and both-level LND in 16 patients (21.3%). Pathological LN metastasis was detected in 20 patients (26.7%) among the 75 patients undergoing LND. There was a significant difference in the number of LN stations (P = 0.015) and metastasis factor (P = 0.0042) between pathologically LN-positive and pathologically LN-negative patients. The sensitivity of enlarged LNs on preoperative computed tomography was 18.2%. There was a tendency towards worse overall survival of pathologically N2-positive patients, although the difference was not statistically significant (P = 0.15). CONCLUSIONS: Preoperative CT appears to play a limited role in detecting pathological LN metastases. Our findings suggest that the significance of N1- and N2-level LND should be evaluated in prospective studies to optimize the postoperative management of patients with thymic carcinomas and neuroendocrine carcinomas.
Authors: Paul De Leyn; Christophe Dooms; Jaroslaw Kuzdzal; Didier Lardinois; Bernward Passlick; Ramon Rami-Porta; Akif Turna; Paul Van Schil; Frederico Venuta; David Waller; Walter Weder; Marcin Zielinski Journal: Eur J Cardiothorac Surg Date: 2014-02-26 Impact factor: 4.191