Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry

Alessandro Bertani, Alessandro Gonfiotti, Mario Nosotti, Paolo Albino Ferrari, Lavinia De Monte, Emanuele Russo, Gioacchino Di Paola, Piero Solli, Andrea Droghetti, Luca Bertolaccini, Roberto Crisci, Carlo Curcio, Dario Amore, Giuseppe Marulli, Samuele Nicotra, Andrea De Negri, Paola Maineri, Gaetano di Rienzo, Camillo Lopez, Angelo MorelliFrancesco Londero, Lorenzo Spaggiari, Roberto Gasparri, Guido Baietto, Caterina Casadio, Maurizio Infante, Cristiano Benato, Marco Alloisio, Edoardo Bottoni, Giuseppe Cardillo, Francesco Carleo, Franco Stella, Giampiero Dolci, Francesco Puma, Damiano Vinci, Giorgio Cavallesco, Pio Maniscalco, Luca Ampollini, Paolo Carbognani, Alberto Terzi, Andrea Viti, Giampiero Negri, Alessandro Bandiera, Reinhold Perkmann, Francesco Zaraca, Claudio Andretti, Camilla Poggi, Felice Mucilli, Pierpaolo Camplese, Alessandro Stefani, Italian VATS Group

Research output: Contribution to journalArticle

Abstract

Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.

Original languageEnglish
Pages (from-to)2061-2070
Number of pages10
JournalJournal of Thoracic Disease
Volume9
Issue number7
DOIs
Publication statusPublished - Jul 1 2017

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Video-Assisted Thoracic Surgery
Disease Management
Registries
Lymph Nodes
Lymph Node Excision
ROC Curve
Area Under Curve

Keywords

  • Lymph node (LN)
  • Nodal upstaging
  • VATS lobectomy

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Nodal management and upstaging of disease : Initial results from the Italian VATS Lobectomy Registry. / Bertani, Alessandro; Gonfiotti, Alessandro; Nosotti, Mario; Ferrari, Paolo Albino; De Monte, Lavinia; Russo, Emanuele; Di Paola, Gioacchino; Solli, Piero; Droghetti, Andrea; Bertolaccini, Luca; Crisci, Roberto; Curcio, Carlo; Amore, Dario; Marulli, Giuseppe; Nicotra, Samuele; De Negri, Andrea; Maineri, Paola; di Rienzo, Gaetano; Lopez, Camillo; Morelli, Angelo; Londero, Francesco; Spaggiari, Lorenzo; Gasparri, Roberto; Baietto, Guido; Casadio, Caterina; Infante, Maurizio; Benato, Cristiano; Alloisio, Marco; Bottoni, Edoardo; Cardillo, Giuseppe; Carleo, Francesco; Stella, Franco; Dolci, Giampiero; Puma, Francesco; Vinci, Damiano; Cavallesco, Giorgio; Maniscalco, Pio; Ampollini, Luca; Carbognani, Paolo; Terzi, Alberto; Viti, Andrea; Negri, Giampiero; Bandiera, Alessandro; Perkmann, Reinhold; Zaraca, Francesco; Andretti, Claudio; Poggi, Camilla; Mucilli, Felice; Camplese, Pierpaolo; Stefani, Alessandro; Italian VATS Group.

In: Journal of Thoracic Disease, Vol. 9, No. 7, 01.07.2017, p. 2061-2070.

Research output: Contribution to journalArticle

Bertani, A, Gonfiotti, A, Nosotti, M, Ferrari, PA, De Monte, L, Russo, E, Di Paola, G, Solli, P, Droghetti, A, Bertolaccini, L, Crisci, R, Curcio, C, Amore, D, Marulli, G, Nicotra, S, De Negri, A, Maineri, P, di Rienzo, G, Lopez, C, Morelli, A, Londero, F, Spaggiari, L, Gasparri, R, Baietto, G, Casadio, C, Infante, M, Benato, C, Alloisio, M, Bottoni, E, Cardillo, G, Carleo, F, Stella, F, Dolci, G, Puma, F, Vinci, D, Cavallesco, G, Maniscalco, P, Ampollini, L, Carbognani, P, Terzi, A, Viti, A, Negri, G, Bandiera, A, Perkmann, R, Zaraca, F, Andretti, C, Poggi, C, Mucilli, F, Camplese, P, Stefani, A & Italian VATS Group 2017, 'Nodal management and upstaging of disease: Initial results from the Italian VATS Lobectomy Registry', Journal of Thoracic Disease, vol. 9, no. 7, pp. 2061-2070. https://doi.org/10.21037/jtd.2017.06.12
Bertani, Alessandro ; Gonfiotti, Alessandro ; Nosotti, Mario ; Ferrari, Paolo Albino ; De Monte, Lavinia ; Russo, Emanuele ; Di Paola, Gioacchino ; Solli, Piero ; Droghetti, Andrea ; Bertolaccini, Luca ; Crisci, Roberto ; Curcio, Carlo ; Amore, Dario ; Marulli, Giuseppe ; Nicotra, Samuele ; De Negri, Andrea ; Maineri, Paola ; di Rienzo, Gaetano ; Lopez, Camillo ; Morelli, Angelo ; Londero, Francesco ; Spaggiari, Lorenzo ; Gasparri, Roberto ; Baietto, Guido ; Casadio, Caterina ; Infante, Maurizio ; Benato, Cristiano ; Alloisio, Marco ; Bottoni, Edoardo ; Cardillo, Giuseppe ; Carleo, Francesco ; Stella, Franco ; Dolci, Giampiero ; Puma, Francesco ; Vinci, Damiano ; Cavallesco, Giorgio ; Maniscalco, Pio ; Ampollini, Luca ; Carbognani, Paolo ; Terzi, Alberto ; Viti, Andrea ; Negri, Giampiero ; Bandiera, Alessandro ; Perkmann, Reinhold ; Zaraca, Francesco ; Andretti, Claudio ; Poggi, Camilla ; Mucilli, Felice ; Camplese, Pierpaolo ; Stefani, Alessandro ; Italian VATS Group. / Nodal management and upstaging of disease : Initial results from the Italian VATS Lobectomy Registry. In: Journal of Thoracic Disease. 2017 ; Vol. 9, No. 7. pp. 2061-2070.
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abstract = "Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the {"}Italian VATS Group{"} prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3{\%}). Nodal upstaging rates were 6.03{\%} (N0-to-N1), 5.45{\%} (N0-to-N2), and 0.58{\%} (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.",
keywords = "Lymph node (LN), Nodal upstaging, VATS lobectomy",
author = "Alessandro Bertani and Alessandro Gonfiotti and Mario Nosotti and Ferrari, {Paolo Albino} and {De Monte}, Lavinia and Emanuele Russo and {Di Paola}, Gioacchino and Piero Solli and Andrea Droghetti and Luca Bertolaccini and Roberto Crisci and Carlo Curcio and Dario Amore and Giuseppe Marulli and Samuele Nicotra and {De Negri}, Andrea and Paola Maineri and {di Rienzo}, Gaetano and Camillo Lopez and Angelo Morelli and Francesco Londero and Lorenzo Spaggiari and Roberto Gasparri and Guido Baietto and Caterina Casadio and Maurizio Infante and Cristiano Benato and Marco Alloisio and Edoardo Bottoni and Giuseppe Cardillo and Francesco Carleo and Franco Stella and Giampiero Dolci and Francesco Puma and Damiano Vinci and Giorgio Cavallesco and Pio Maniscalco and Luca Ampollini and Paolo Carbognani and Alberto Terzi and Andrea Viti and Giampiero Negri and Alessandro Bandiera and Reinhold Perkmann and Francesco Zaraca and Claudio Andretti and Camilla Poggi and Felice Mucilli and Pierpaolo Camplese and Alessandro Stefani and {Italian VATS Group}",
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TY - JOUR

T1 - Nodal management and upstaging of disease

T2 - Initial results from the Italian VATS Lobectomy Registry

AU - Bertani, Alessandro

AU - Gonfiotti, Alessandro

AU - Nosotti, Mario

AU - Ferrari, Paolo Albino

AU - De Monte, Lavinia

AU - Russo, Emanuele

AU - Di Paola, Gioacchino

AU - Solli, Piero

AU - Droghetti, Andrea

AU - Bertolaccini, Luca

AU - Crisci, Roberto

AU - Curcio, Carlo

AU - Amore, Dario

AU - Marulli, Giuseppe

AU - Nicotra, Samuele

AU - De Negri, Andrea

AU - Maineri, Paola

AU - di Rienzo, Gaetano

AU - Lopez, Camillo

AU - Morelli, Angelo

AU - Londero, Francesco

AU - Spaggiari, Lorenzo

AU - Gasparri, Roberto

AU - Baietto, Guido

AU - Casadio, Caterina

AU - Infante, Maurizio

AU - Benato, Cristiano

AU - Alloisio, Marco

AU - Bottoni, Edoardo

AU - Cardillo, Giuseppe

AU - Carleo, Francesco

AU - Stella, Franco

AU - Dolci, Giampiero

AU - Puma, Francesco

AU - Vinci, Damiano

AU - Cavallesco, Giorgio

AU - Maniscalco, Pio

AU - Ampollini, Luca

AU - Carbognani, Paolo

AU - Terzi, Alberto

AU - Viti, Andrea

AU - Negri, Giampiero

AU - Bandiera, Alessandro

AU - Perkmann, Reinhold

AU - Zaraca, Francesco

AU - Andretti, Claudio

AU - Poggi, Camilla

AU - Mucilli, Felice

AU - Camplese, Pierpaolo

AU - Stefani, Alessandro

AU - Italian VATS Group

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.

AB - Background: VATS lobectomy is an established option for the treatment of early-stage NSCLC. Complete lymph node dissection (CD), systematic sampling (SS) or resecting a specific number of lymph nodes (LNs) and stations are possible intra-operative LN management strategies. Methods: All VATS lobectomies from the "Italian VATS Group" prospective database were retrospectively reviewed. The type of surgical approach (CD or SS), number of LN resected (RN), the positive/resected LN ratio (LNR) and the number and types of positive LN stations were recorded. The rates of nodal upstaging were assessed based on different LN management strategies. Results: CD was the most frequent approach (72.3%). Nodal upstaging rates were 6.03% (N0-to-N1), 5.45% (N0-to-N2), and 0.58% (N1-to-N2). There was no difference in N1 or N2 upstaging rates between CD and SS. The number of resected nodes was correlated with both N1 (OR =1.02; CI, 1.01-1.04; P=0.03) and N2 (OR =1.02; CI, 1.01-1.05; P=0.001) upstaging. Resecting 12 nodes had the best ability to predict upstaging (6 N1 LN or 7 N2 LN). The finding of two positive LN stations best predicted N2 upstaging [area under the curve (AUC) of receiver operating characteristic (ROC) =0.98]. Conclusions: Nodal upstaging (and, indirectly, the effectiveness of intra-operative nodal management) cannot be predicted based on the surgical technique (CD or SS). A quantitative assessment of intra-operative LN management may be a more appropriate and measurable approach to justify the extension of LN resection during VATS lobectomy.

KW - Lymph node (LN)

KW - Nodal upstaging

KW - VATS lobectomy

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