Risk factor analysis of mediastinal lymph node metastasis in non-small cell lung cancer patients and the strategy of mediastinoscopy prior to surgery / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To discuss the strategy of mediastinoscopy for the evaluation of mediastinal lymph node status (metastasis or not) of non-small cell lung cancer (NSCLC) prior to surgery.</p><p><b>METHODS</b>From October 2000 to June 2007, 152 consecutive NSCLC cases pathologically proven and clinically staged I-III were enrolled in the study. Of the 152 cases, there were 118 males and 34 females. Age ranged 24-79 years old and the median age was 58. All cases underwent CT and mediastinoscopy for the evaluation of mediastinal lymph node status prior to surgery. Compared with the results of final pathology, the positive rate of mediastinoscopy and the prevalence of mediastinal lymph node metastasis were calculated in the NSCLC patients with negative mediastinal or hilar lymph nodes on CT scan (the shortest axis of mediastinal or hilar lymph nodes <1 cm). Clinical characteristics used as predictive factor including sex, age, cancer location, type of pathology, T status, cancer type (central or peripheral), size of mediastinal lymph nodes (the shortest axis <1 cm or >1 cm) on CT scan and serum CEA level were analyzed by univariate and multivariate analysis with Binary logistic regression model to identify risk factors of mediastinal metastasis.</p><p><b>RESULTS</b>The positive rate of mediastinoscopy was 11.6% (8/69) and the prevalence of mediastinal metastasis was 20.1% (14/69) in NSCLC with negative mediastinal or hilar lymph nodes on CT scan respectively. In clinical stage I (cT1-2N0M0) NSCLC the positive rate of mediastinoscopy was 11.3% (7/62), N2 accounting for 6.5% (4/62) and N3 4.8% (3/62), respectively; and the prevalence of mediastinal lymph node metastasis was 19.4% (12/62), N2 ccounting for 14.6% (9/62) and N3 4.8% (3/62), respectively. In the whole group both univariate and multivariate analysis showed that adenocarcinoma or mediastinal lymph nodes > or =1 cm in the shortest axis on CT scan was an independent risk factor to predict mediastinal lymph node metastasis. In NSCLC with negative mediastinal or hilar lymph nodes on CT scan both univariate and multivariate analysis showed that adenocarcinoma was a predictor of mediastinal lymph node metastasis. Conclusion We recommend the policy of routine mediastinoscopy in NSCLC prior to surgery if the mediastinal staging was only based on CT scan. Mediastinal lymph nodes > or =1 cm in the shortest axis on CT scan mandates preoperative mediastinoscopy. Adenocarcinoma also indicates mandatory mediastinoscopy even with negative mediastinal or hilar lymph nodes on CT scan.</p>

Prospective comparison of CT versus mediastinoscopy in preoperative evaluation of mediastinal lymph node status in patients with non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the value of CT and mediastinoscopy in assessment of mediastinal lymph node status in potentially operable non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>From Oct. 2000 to Jun. 2007, 152 consecutive patients with pathologically proven and stage I to approximately III NSCLC were enrolled into the study. Of the 152 cases, there were 118 males and 34 females, with a median age of 58 years (range, 24 to approximately 79 years). Compared with the final pathology, the sensitivity, specificity, positive and negative predictive values and accuracy of CT and mediastinoscopy for preoperative evaluation of mediastinal lymph node status were calculated, respectively. The accuracy and diagnostic efficacy of CT and mediastinoscopy was compared by Pearson chi(2) test and ROC curve, respectively.</p><p><b>RESULTS</b>The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of detection of mediastinal metastasis was 73.8%, 70.1%, 64.9%, 78.2% and 71.7% by CT, respectively, versus 83.1%, 100.0%, 100.0%, 88.8% and 92.8% by mediastinoscopy, respectively. Both the accuracy and diagnostic efficacy of mediastinoscopy were superior to CT (Pearson chi(2) test, P < 0.001; Z test of the areas under the ROC curve, P < 0.001). The complication rate of mediastinoscopy was 4.6%, and the false negative rate was 7.2%.</p><p><b>CONCLUSION</b>Mediastinoscopy is safe and effective in preoperative assessment of mediastinal lymph node status in potentially operable NSCLC, while CT alone is inadequate.</p>

Methods of preserving intercostobrachial nerve during breast cancer operation and its clinical value / 中华外科杂志

<p><b>OBJECTIVE</b>To study the methods and the clinical value of preserving intercostobrachial nerve during the axillary lymph nodes excision in breast cancer operations.</p><p><b>METHODS</b>One hundred and sixty-two cases of stages I, II, IIIa breast cancer patients were divided into experimental group and control group respectively. The intercostobrachial nerves were preserved in experimental group and not in control group. Both groups were treated following the practice guideline of breast cancer, and found no recurrence during 4 to 36 months following up.</p><p><b>RESULTS</b>The postoperative arm sensory disturbance was 22.2% in the experimental group, which was significantly different from that of the control group 73.3% (chi(2) = 41.80, P < 0.01), the incidence of pain is 12.5% in experimental group, which was also significantly different from that of control group 31.1% (chi(2) = 7.86, P < 0.01).</p><p><b>CONCLUSION</b>Preserving intercostobrachial nerves may significantly decrease the postoperative morbidity of arm sensory disturbance and pain during axillary excision of stage I, II, IIIa breast cancer patients.</p>

Giant pathologic section in the study of optimal length of surgical resection for esophageal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the optimal surgical resection length for esophageal carcinoma.</p><p><b>METHODS</b>Specimens of seventy patients with esophageal squamous cell carcinoma resected and collected in our hospital were made into pathologic giant sections. Direct intramural infiltration, multicentric carcinogenic lesion and leaping metastasis were observed in the large slice by microscope. The actual length during the operation was calculated by the ratio of shrinkage.</p><p><b>RESULTS</b>Direct intramural infiltration was found in 51 (72.9%) patients, 39 proximal and 36 distal to the tumor. The mean length of direct intramural infiltration was 0.9 +/- 0.8 cm (4.0 cm maximum) proximally and 0.5 +/- 0.3 cm (2.0 cm maximum) distally. Multicentric carcinogenic lesion was found in 11 (15.7%) patients, 5 proximally, 8 distally and 2 on both sides. Proximal to the tumor, the mean distance between the multicentric carcinogenic lesion and the main lesion plus the length of the multiple carcinogenic lesion was 3.2 +/- 1.5 cm (4.7 cm maximum). Distal to the tumor, it was 3.6 +/- 2.4 cm (9.1 cm maximum). Leaping metastasis was found in 9 (12.9%) patients, 7 proximally and 4 distally. The mean distance between the leaping metastasis and the main lesion plus the length of the leaping metastatic lesion was 1.9 +/- 0.6 cm (2.9 cm maximum) proximally and 1.4 +/- 1.0 cm (2.7 cm in maximum) distally.</p><p><b>CONCLUSION</b>The optimal surgical resection length for esophageal carcinoma should be at least 5 cm proximal to the tumor and total length on the distal side.</p>