Download PDF
Thorac Cardiovasc Surg 2006; 54(6): 373-380
DOI: 10.1055/s-2006-924194
Editorial

© Georg Thieme Verlag KG Stuttgart · New York

Lymphatic Spread in Resectable Lung Cancer: Can We Trust in a Sentinel Lymph Node?

J. Schirren1 , T. Bergmann1 , S. Beqiri1 , S. Bölükbas1 , A. Fisseler-Eckhoff1 , I. Vogt-Moykopf2
  • 1Department of Thoracic Surgery, HSK-Wiesbaden, Wiesbaden, Germany
  • 2Former Head of Department of Thoracic Surgery, Thoraxklinik, Heidelberg-Rohrbach, Germany
Further Information

Publication History

Received December 19, 2005

Publication Date:
07 September 2006 (online)

    Permissions and Reprints All articles of this category

Abstract

The aim of this study was to describe lymphatic spread in resected lung cancer patients and evaluate for the presence for a reliable sentinel lymph node. Onethousand and eighty-eight patients with NSCLC underwent resection. Twelve to sixteen percent of the patients with primaries in the upper lobes had an involvement in the upper mediastinum; in 12 %, it was subcarinal, in 6 % and 3 %, in the lower mediastinum at paraoesophageal and ligamentum pulmonale sites, respectively. The rate of “lymph node skipping” is between 31 and 74 %. An isolated involvement of mediastinal nodes is possible without involvement of the N-1 position. Irrespective of the location of the primary tumour, there is a high incidence of “lymph node skipping” because of the specific architecture of the pulmonary, hilar and medistinal lymph nodes. Therefore, a reliable sentinel lymph node in lung cancer cannot be defined. In conclusion, systematic lymph node dissection in anatomical compartments is the gold standard for evaluation of the exact pN stage. Furthermore, a complete R/O-resection is a prognostically relevant factor in the surgery of NSCLC.

Key words

NSCLC - lymphatic spread - sentinel lymph node - lymph node skipping - systematic lymph node dissection

References

  • 1 Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastases in resected lung cancer.  J Thorac Cardiovasc Surg. 1978;  76 832-839
    PubMedGoogle Scholar
  • 2 Riepert T, Müller K M. Tumorausbreitung in Lungen mit Silikosen.  Verh Deutsch Ges Pathol. 1984;  68 407-409
    PubMedGoogle Scholar
  • 3 Kubik S. Anatomie der Lymphgefäße der Lunge. Eckert P Intensivmedizin Anaesthesiologie. Vol. 2: Volumenregulation und Flüssigkeitslunge. Stuttgart; Thieme Verlag 1976: 10-16
    Google Scholar
  • 4 Hata E, Troidl H, Haegawas T. In-vivo-Untersuchung der Lymphoszintigraphie: Eine neue diagnostische Technik. Hamelmann H, Troidl H Behandlung des Bronchialkarzinoms. Stuttgart; Thieme Verlag 1981: 27
    Google Scholar
  • 5 Hoffmann E. Die Abflußwege der Lymphe und ihre Bedeutung für die Ausbreitung maligner Tumoren.  Bruns Beitr Klin Chir. 1959;  199 451-457
    PubMedGoogle Scholar
  • 6 Knoche E, Ring H. Die Mediastinoskopie. Stuttgart; Schattauer 1964
    Google Scholar
  • 7 Riquet M, Hidden G, Debesse B. Direct lymphatic drainage of lung segments to the mediastinal nodes. An anatomic study on 260 adults.  J Thorac Cardiovasc Surg. 1989;  97 623-632
    PubMedGoogle Scholar
  • 8 Murakami G, Taniguchi I. Histological heterogeneity and intra nodal shunt flow in lymph nodes from elderly subjects: a cadaveric study.  Ann Surg Oncol. 2004;  11 279-284
    CrossrefPubMedGoogle Scholar
  • 9 Borrie J. Lung Cancer: Surgery and Survival. New York; Appleton-Centry-Crofts 1965
    Google Scholar
  • 10 Martini F, Flehinger B J. The role of surgery in N2 lung cancer.  Surg Clin North Am. 1987;  67 1037-1045
    PubMedGoogle Scholar
  • 11 UICC and AJCC TNM-Supplement. Heidelberg, New York; Springer 1997
    Google Scholar
  • 12 Kiyono K, Sone S, Sakai F, Imai Y. et al . The number and size of normal mediastinal lymph nodes: a post mortem study.  AJR. 1988;  150 771-776
    PubMedGoogle Scholar
  • 13 Little A G, Delloyos A, Kirgan D M, Arcomano T R, Murray K D. Intraoperative lymphatic mapping for non-small cell cancer: the sentinel node technique.  J Thorac Cardiovasc Surg. 1999;  117 220-234
    PubMedGoogle Scholar
  • 14 Greschuchna G, Maassen W. Die lymphogenen Absiedlungswege des Bronchialkarzinoms. Stuttgart; Thieme Verlag 1973: 25-52
    Google Scholar
  • 15 Libsitz H I, McKenna R J, Montain C F. Patterns of mediastinal metastases in bronchogenic carcinoma.  Chest. 1986;  90 229-235
    PubMedGoogle Scholar
  • 16 Mozzilo N, Chiesa F, Botti G. et al . Sentinel node biopsy in head and neck cancer.  Ann Surg Oncol. 2001;  135 926-932
    PubMedGoogle Scholar
  • 17 Schmidt F E, Woltering E A, Webb W R, Garcia O M, Cohen J E, Rozans M H. Sentinel nodal assessment in patients with carcinoma of the lung.  Ann Thorac Surg. 2002;  74 870-875
    CrossrefPubMedGoogle Scholar
  • 18 Tsioulias G J, Wood T F, Morton D L. et al . Lymphatic mapping and focused analysis of sentinel lymph nodes upstage gastrointestinal neoplasm.  Arch Surg. 2000;  135 926-932
    PubMedGoogle Scholar
  • 19 Schirren J. Die systematische mediastinale Lymphknotendissektion beim Bronchialkarzinom. Indikation, Technik, Ergebnisse. Habilitationsschrift Medizinische Gesamtfakultät der Ruprecht-Karls-Universität zu Heidelberg. 1995
    Google Scholar
  • 20 Schirren J, Richter W, Schneider P, Vogt-Moykopf I. Grundlagen und Ergebnisse der systematischen Lymphknotendissektion beim operierten Bronchialkarzinom.  Chirurg. 1996;  67 869-876
    CrossrefPubMedGoogle Scholar
  • 21 Junker K, Müller K M. Metastasierung beim Bronchialkarzinom.  Z Herz Thorax Gefäßchir. 1989;  3 189-194
    PubMedGoogle Scholar
  • 22 Schirren J, Schneider P, Richter W, Trainer C, Muley T, Bülzebruck H, Vogt-Moykopf I. Radikalität und Lymphknotendissektion beim Lungenkarzinom.  Langenbecks Arch Chir. 1996;  (Suppl 2) 790-797
    PubMedGoogle Scholar
  • 23 Morton D L, Wen D, Wong J. et al . Technical details of intraoperative lymphatic mapping for early stage melanoma.  Arch Surg. 1992;  127 392-399
    CrossrefPubMedGoogle Scholar
  • 24 Aiku T, Higashi H, Natsugoe S. et al . Can sentinel node navigation surgery reduce the extent of lymph node dissection in gastric cancer?.  Ann Surg Oncol. 2001;  8 90-93
    PubMedGoogle Scholar
  • 25 Liptay M D, Masters G A, Winchester D J, Edelman B L, Garrido B J, Hirschtritt T R, Perlman R M, Fry W A. Intraoperative radioisotope sentinel lymph node mapping in non-small cell lung cancer.  Ann Thoracic Surg. 2000;  70 384-389
    PubMedGoogle Scholar

MD, PhD, FECTS Joachim Schirren

Department of Thoracic Surgery
HSK-Wiesbaden

Ludwig-Erhard-Straße 100

65199 Wiesbaden

Germany

Phone: + 49 6 11 43 31 32

Fax: + 49 6 11 43 31 32

Email: joachim.schirren@hsk-wiesbaden.de

      >