The authors declare that they have no competing interests.
CWL contributed to the conception and design of the study, and drafted the manuscript; QP contributed to the conception and design of the study and acquisition of data; CLG contributed to the acquisition of data and analysis and interpretation of data; ZLX contributed to the acquisition, analysis and interpretation of data; JDM participated in the design and coordination of the study and helped to draft the manuscript; LM participated in the design and coordination of the study and helped to draft the manuscript; YKZ participated in the design and coordination of the study and helped to draft the manuscript; HL contributed to the acquisition, analysis and interpretation of data, and helped to draft the manuscript; LXL contributed to the conception and design of the study, to be leading surgeon fulfilled all the operations of this series cases, and revised the manuscript. All authors read and approved the final manuscript.
This study aims to introduce an optimized method named “non-grasping en bloc mediastinal lymph node dissection (MLND)” through video-assisted thoracoscopic surgery (VATS).
Between February 2009 and July 2013, 402 patients with clinical stage I non-small cell lung cancer (NSCLC) underwent “non-grasping en bloc MLND” conducted by one surgical team. Target lymph nodes (LNs) were exposed following non-grasping strategy with simple combination of a metal endoscopic suction and an electrocoagulation hook or an ultrasound scalpel. In addition, dissection was performed following a stylized three-dimensional process according to the anatomic features of each station. Clinical and pathological data were prospectively collected and retrospectively reviewed.
The postoperative morbidity and mortality were 17.4% (70/402) and 0.5% (2/402), respectively. The total number of LNs (N1 + N2) was 16.0 ± 5.9 (range of 5–52), while the number of N2 LNs was 9.5 ± 4.0 (range of 3–23). The incidences of postoperative upstaging from N0 to N1 and N2 disease were 7.7% and 12.2%, respectively.
Non-grasping en bloc MLND enables en bloc dissection of mediastinal LNs with comparable morbidity and oncological efficacy while saving troubles of excessive interference of instruments and potential damage to the target LN.
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- Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery
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