INTRAOPERATIVE SURGICAL STAGING

Intraoperative surgical staging
resection of a lung cancer includes a thorough assessment of
hilar and mediastinal lymph nodes, and something but
this constitutes a substandard operation. 59, sixty it's important
to recognize the differences between a selective node sampling
( limited sampling directed by “judgment” ), a systematic sampling
( a minimum of one representative node from every ipsilateral
mediastinal station ), an entire mediastinal lymph node dissection
( lnd, removal of all ipsilateral nodal tissue ), and a
lobe-specific node operation ( removal of all nodal tissue within the
mediastinal node stations most commonly affected for that
lobe ). either a systematic sampling or an entire node dissection
ought to be done, though a lobe- specific systematic node
operation is also appropriate in a few circumstances. 60
many randomized and controlled studies have demonstrated
that systematic sampling or node operation provides
additional correct staging data than a selective-node sampling.
61–63 stage classification is constant when systematic
mediastinal node sampling versus a formal lymph node operation.
61, 64–66 there's no increase in morbidity or mortality
when lnd. sixty five as a result of adjuvant therapy is recommended
for patients with nodal involvement, an operation that omits
a thorough nodal assessment should be condemned as being of
unacceptable quality. this can be true whether or not the procedure is performed
via thoracotomy or thoracoscopy, and applies to sublobar
resection furthermore.
whether or not there's a therapeutic profit to an entire lymph
node operation is controversial. 63, 67–69 2 randomized studies
have found no differences in recurrence rates or survival
in patients undergoing lnd versus systematic lymph node
sampling ( in 115 patients with 2-cm pathologic stage i pi
nsclc and 182 ci to iiia patients ). 68, 69 another randomized
study found a profit to lnd as compared with selective sampling,
though this was potentially confounded by higher staging
when lnd. 63 finally, 2 retrospective studies have found
conflicting results. 67, 70 the long-term survival results of the
completed yankee school of surgeons oncology group
randomized trial of mediastinal node operation ( acosog
z0030 ) aren't nevertheless on the market