Transcervical Extended Mediastinal Lymphadenectomy (TEMLA) for staging of non-small-cell lung cancer (NSCLC)

Marcin Zieliński, Łukasz Hauer, Jolanta Hauer, Juliusz Pankowski, Artur Szlubowski, Tomasz Nabiałek

Abstract


Introduction: The aim of the study is to analyze diagnostic yield of the new surgical technique - the Transcervical
Extended Mediastinal Lymphadenectomy (TEMLA) in preoperative staging of Non-Small-Cell Lung Cancer (NSCLC)

Material and methods: Operative technique included 5-8 cm collar incision in the neck, elevation of the sternal manubrium
with a special retractor, bilateral visualization of the laryngeal recurrent and vagus nerves and dissection of all mediastinal
nodal stations except of the pulmonary ligament nodes (station 9).

Results: 698 patients (577 men, 121 women), of mean age 62.8 (41-79) were operated on from 1.1.2004 to 31.1.2010,
including 501 squamous-cell carcinomas, 144 adenocarcinomas, 25 large cell carcinomas and 28 others. Mean operative
time was 128 min. (45 to 330 min) and 106.5 min. in the last 100 patients. 30-day mortality was 0.7 % (unrelated causes)
and morbidity 6.6%. The mean number of dissected nodes during TEMLA was 37.9 (15 to 85). Metastatic N2 and N3 nodes
were found in 152/698 (21.8%) and 26/698 patients (3.7%), respectively. Subsequent thoracotomy was performed in 445/513 patients (86.7%) after negative result of TEMLA. During thoracotomy, omitted N2 was found in 7/445 (1.6%) patients.
Sensitivity of TEMLA in discovery of metastatic N2-3 nodes was 96.2 %, specificity was 100%, accuracy was 99,0%,
Negative Predictive Value (NPV) was 98.7 % and Positive Predictive Value (PPV) was 100%.

Conclusions: TEMLA is a new minimally invasive surgical procedure providing unique possibility to perform very extensive,
bilateral mediastinal lymphadenectomy with very high diagnostic yield in staging of NSCLC

Pneumonol. Alergol. Pol. 2011; 79, 3: 196-206

Keywords

lung cancer; mediastinum; lymph nodes

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