Nodal Upstaging in VATS Anatomical Resections for NSCLC

Study Overview
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Brief Summary
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This study investigates peropeative nodal upstaging during anatomical resections for non-small-cell-lung-cancer in an era of rising numbers of VATS anatomical resections. In case of comparable study groups, unchanged pretreatment staging and equal quality of pathologic examination, lymph node upstaging is a marker of surgical quality and can be used to study the quality of a new surgical technique.

Detailed Description
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Vats lobectomy is becoming the standard of care for early stage lung cancer. Several studies have shown feasibility and safety in dedicated centres. Compared to thoracotomy the procedure is believed to achieve equal oncologic results and survival, perhaps better. Publications have shown that mediastianal lymph node dissection during VATS is similar. However, two recent reports have shown potential lower N1 (hilar and intrapulmonary) upstaging in VATS surgery After optimal staging the percentage of unforeseen N+ the percentage of unforeseen positive nodes can reach 15% Nodal upstaging at final pathology is dependent on the quality of: pretreatment staging, the better, the less upstaging surgery, ie mediastinal, hilar and intrapulmonary lymphadenectomy pathologic examination If we accept that pretreatment staging and pathologic examination are equal in two comparable surgical cohorts, the finding of unforeseen N+ or nodal upstaging is a quality marker of surgery. When surgical techniques are changing, it is important to look at this marker. In absence of a randomized trial, we believe a cohort analysis is useful. By including all patients, open or vats, and comparing cohorts instead of the surgical technique used, the selection bias is absent. We compare three cohorts. In the first (20007-2009) almost all patients where operated through a thoracotomy. In a second cohort, (2010-2011) the experience with vats was early. In the third period (2012-2013), a standardized vats technique with extensive intrapulmonary and mediastinal lymphadenectomy was used.

Official Title
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Cohort Analysis of Nodal Upstaging in the Era of Increase of VATS Anatomical Resections for NSCLC

Conditions
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Carcinoma, Non-Small-Cell Lung

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All cN0, cN1 patients that underwent segmentectomy, lobectomy, sleeve lobectomy for NSCLC. Exclusion Criteria: cN2 cM+ Pneumonectomy Previous lung cancer surgery - lymphadenectomy Neo-adjunvant therapy Lung Tx Bilateral lesions

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| open thoracotomy<br>In the first cohort(20007-2009) almost all patients where operated through a thoracotomy. | |
| Early VATS<br>In a second cohort, (2010-2011) the experience with vats was early. | |
| Standardized VATS<br>In the third period (2012-2013), a standardized vats technique with extensive intrapulmonary and mediastinal lymphadenectomy was used. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| proportion of N upstaging | clinical N0 to pathological N1 clinical N0 to pathological N2 clinical N1 to pathological N2 | at time of surgical resection | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lymph Node Excision, Thoracic Surgical Procedures, Thoracic Surgery, Video-Assisted, Thoracotomy