Laurence Solovei, Pierre Rabinel, Mathilde Cazaux, Claire Renaud, Jean Berjaud, Marcel Dahan, Laurent Brouchet
Institution : Service de chirurgie thoracique, hôpital Larrey, CHU de Toulouse
Objectives : To analyse nodal upstaging for clinical T1-T2 N0 non-small cell lung cancer (NSCLC) in the mini-invasive techniques versus thoracotomy by analyzing the new edition of the French thoracic surgery database.
Methods : The new Epithor database, available since December 2015, allows us to compare the clinical and pathological TNM stages of NSCLC. We retrospectively analyzed the data of patients with clinical stage I CBNPC who had surgery. The different surgical approaches were evaluated : open surgery (OS) versus mini-invasive techniques (MIT). The characteristics of population, clinical and pathological TNM, global, N1 and N2 nodal upstaging rates were studied.
Results : Between December 2015 and September 2016, among 1787 CBNPC cT1-T2 N0 treated by surgery. 1399 lobectomies were listed (78.3%) : 644 (46%) by OS, 143 (10.2%) by video assisted thoracotomy (VA), 455 (32.5%) by thoracoscopy (VATS) and 156 (11.2%) by robotics (RATS). The global nodal upstaging was 12.4%. The rates of nodal upstaging according to the surgical approach : OS, VA, VATS and RATS are 12,6 / 16,1 / 11,9 and 10.3% respectively. No significant difference was found between these figures (p>0.05). An identical number of nodal upstaging cN0-pN1 and cN0-pN2 was found (50-50%).
Conclusion : Nodal upstaging is considered as a tool to assess the oncologic quality of surgery. Controversy remains regarding the lymph node evaluation achieved by VATS. Many international studies report lower nodal upstaging rates versus OS and RATS. According to the new EPITHOR database, lymph node evaluation is not significantly different from a technique to an other. In other academic centers, similar results has been reported as well as long-term survival datas. The actual lack of randomized studies prevent us from eliminating selection biases to conclude on the superiority of a surgical approach from another one.