Effect of thoracoscopic right upper mediastinal dissection for left lung cancer-Especially about micrometastasis to lymph nodes-

工作背景：I期非小细胞左肺癌患者的生存率不高，可能是因为对侧纵隔淋巴结受累的发生率较高。在这项研究中，我们回顾性研究了隐匿性微转移到右上纵隔淋巴结的患者I期左肺癌使用实时定量逆转录聚合酶链反应（RT-PCR）的方法。材料和方法：21例临床I期左非小细胞肺癌患者接受了VATS肺叶切除术和双侧纵隔淋巴结清扫术（BMD）。将BMD患者的临床资料和生存率与27例左侧单侧纵隔淋巴结清扫（UMD）患者进行比较。采用细胞角蛋白19 mRNA RT-PCR方法检测隐匿性微转移。结果如下：BMD组和UMD组的手术时间、术中出血量、胸管引流时间和术后住院时间无差异。病理性N2病1例。20例患者患有pN 0疾病。右纵隔淋巴结微转移9/21例（42。8%的患者。7/9例（77. 7%）转移至N3淋巴结，无N1、N2淋巴结转移。8%的患者。BMD患者均存活，中位随访13年无复发。9个月BMD组与UMD组的3年总生存率和3年无病生存率无显著差异。结论：胸腔镜下右上纵隔清扫术治疗左肺癌安全可行。在我们的初步研究中，隐匿性微转移到水平N3淋巴结经常发生在临床N 0期非小细胞左肺癌患者。N3淋巴结隐匿性微转移患者的术后生存率可能并不差。需要进一步的后续行动和工作。

Background : Survival of patients with stage I non-small cell left lung cancer is not sufficient, probably, because of high incidence of the contralateral mediastinal node involvement. In this study, we investigated retrospectively occult micrometastases to the right upper mediastinal nodes in patients with stage I left lung cancer using a real-time quantitative reverse transcription-polymerase chain reaction(RT-PCR) method. Material and methods : 21 patients with clinical stage I non-small-cell left lung cancer underwent VATS lobectomy and bilateral mediastinal lymph node dissection(BMD). Clinical data and survival of patients with BMD were compared with those of 27 left-unilateral mediastinal node dissection(UMD). Occult micrometastases were detected using cytokeratin 19 mRNA RT-PCR method. Results : The operative time, blood loss, duration of chest tube drainage, and duration of postoperative hospital stay were not different between BMD and UMD patients. Pathological N2 disease was one patients. 20 patients had pN0 disease. Nodal micrometastases of right mediastinum were detected in 9/21(42. 8%) patients. Skip micrometastases to the level N3 nodes without the N1and N2 node involvement was observed in 7/9(77. 8%) patients. Patients with BMD are all alive and have no recurrence during median follow-up period of 13. 9 months. Overall 3-year survival and disease free 3-year survival of BMD patients were not significant difference from those of UMD patients. Conclusion : Thoracoscopic right upper mediastinal dissection for left lung cancer is safe and feasible. In our preliminary study, occult micrometastases to the level N3 nodes occurred frequently in patients with clinical N0 stage I non-small cell left lung cancer. Possibly, postoperative survival of patients with occult micrometastases to the level N3 node is not poor. Further follow up and work are needed.