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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Third Mediterranean Symposium on Thoracic Surgical Oncology, Catania, Italy, 21-22 April 2016 The primary justification for mediastinal lymphadenectomy is that it provides more complete nodal staging to help select best adjuvant treatments. There is a secondary argument that dissection of nodes might remove otherwise unrecognized nodal disease to increase the chance of cure. They have to be thought through again as patients look for less invasive treatments for their cancers such as videothoracoscopy and stereotactic radiotherapy. Evidence from analysis of Surveillance, Epidemiology and End Results data indicated that sampling or dissection can be performed adequately by surgeons using videothoracoscopy but stereotactic radiotherapy of its nature precludes intraoperative lymph node dissection and yet is being promoted as equivalent treatment. Consideration of these issues requires re-examination of the evidence that lymphadenectomy influences survival.
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PMID:Rethinking N2 disease in the era of uniportal video-assisted thoracic surgery. 2764 Feb 20

An accurate staging of a malignant disease is imperative in order to plan pre- and post-operative therapy, define prognosis and compare studies. According to the European Society of Thoracic Surgeons (ESTS) guidelines a systematic lymph node (LN) dissection is recommended in all cases of pulmonary resection for non-small cell lung cancer (NSCLC). The current lung cancer staging system considers the lymphatic stations involved but not the number of LNs. Up to date, published scientific studies on hilar and mediastinal lymphadenectomy mainly have been regarded the type of LN dissection procedure after pulmonary resection (selected LN biopsy, LN sampling, systematic nodal dissection, lobe specific nodal dissection and extended LN dissection) focusing particularly on the comparison between mediastinal LN dissection (MLND) and mediastinal LN sampling (MLNS). Recently, further investigations have been concentrated on surgical approach (videothoracoscopic vs. thoracotomic approach) used to perform pulmonary resection and following LN dissection in order to achieve a complete mediastinal lymphadenectomy. This short synthesis aims to present the current experiences in this setting.
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PMID:Lymph node dissection after pulmonary resection for lung cancer: a mini review. 2782 71

Stage IIIA is a very heterogeneous group encompassing locally advanced disease with T3 and T4 tumors without any nodal involvement and very small T1a primary tumors with unilateral mediastinal lymphatic disease. Tailored management defines interdisciplinary management requiring board decisions, which can sometimes be difficult particularly in stage IIIa non-small-cell lung cancer (NSCLC). Lobectomy still is standard of care even for stage I NSCLC, which increasingly is implemented using minimally invasive surgical technique. On the other hand even locally extended tumors are today safely resected with low morbidity and mortality. According to the 2015 guidelines of the European Society of Thoracic Surgeons any kind of anatomical lung resection for lung cancer with curative intent has to be accompanied by formal mediastinal lymph node dissection. The transcervical route for complete bilateral mediastinal lymphadenectomy offers improved completeness of resection without the need for single lung ventilation and ideally supports the concept of minimally invasive surgery.
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PMID:Tailored management of stage IIIa non-small-cell lung cancer in the era of the 8th edition of the TNM classification for lung cancer. 2966 58

Diagnosis and clinical staging of lung cancer are fundamental to planning therapy. The techniques for clinical staging, i.e anatomic and metabolic imaging, endoscopies and minimally invasive surgical procedures, should be performed sequentially and with an increasing degree of invasiveness. Intraoperative staging, assessing the magnitude of the primary tumour, the involved structures, and the loco-regional lymphatic spread by means of systematic nodal dissection, is essential in order to achieve a complete resection. In resected tumours, pathological staging, with the systematic study of the resected specimens, is the strongest prognostic indicator and is essential to make further decisions on therapy. In the present decade, the guidelines on lung cancer staging of the American College of Chest Physicians and the European Society of Thoracic Surgeons are based on the best available evidence and are widely followed. Recent advances in the classification of the adenocarcinoma of the lung, with the definition of adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma, and the publication of the eighth edition of the tumour, node and metastasis classification of lung cancer, have to be integrated into the staging process. The present review complements the latest guidelines on lung cancer staging by providing an update of all these issues.
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PMID:Lung cancer staging: a concise update. 3009 59

Ovarian cancer is the seventh most common cancer in women and the eighth most common cause of cancer death in the world with an overall 5-year survival rate of <50%. (1) The most common age of presentation is at the perimenopausal age group and two-thirds of them present with advanced stage of disease. (2) Thoracic metastases occur in up to 50% of patients. Pleural effusion is the most common presentation of thoracic metastases in these patients, whereas pulmonary parenchymal metastases, lymphangitis, and nodal involvement are less commonly reported. (3) Tracheobronchial involvement is rare with few cases reported in literature. Herewith, we are presenting a case of ovarian cancer in a young female with both lung parenchymal and endobronchial metastases. Bronchoscopy revealed endobronchial tumor in right lower lobe bronchus part of which was covered by yellowish necrotic material. Biopsy showed metastatic ovarian malignancy complicated by aspergillosis. She was started on oral itraconazole along with supportive management following which hemoptysis stopped.
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PMID:Lung Parenchymal and Endobronchial Metastases From Ovarian Carcinoma. 2994 89

Accurate staging of lung cancer is of utmost importance in determining the stage-appropriate treatment and prognosis. Imaging tests which include contrast-enhanced computed tomography (CT) examination of the chest to include the liver and adrenal glands and 18-fluoro-2 deoxyglucose positron emission tomography (PET)/CT scan facilitate the initial tumor node metastasis (TNM) staging of the disease and provide guidance on the optimal biopsy site and biopsy method. The diagnostic and staging approach should be tailored to the individual patient according to risk, benefit, patient preferences, and available expertise. Diagnosis and staging should preferably be accomplished with a single procedure or the least number of invasive procedures if more than one is needed. Ideally, centers managing lung cancer patients should have a multidisciplinary thoracic oncology board prescribing personalized evidence-based management tailored to each individual patient. Multidisciplinary team (MDT) meetings provide a platform for key experts from various disciplines to contribute specific advice on the management of each individual patient. As assessment of mediastinal lymph node involvement is an important component of lung cancer staging, optimal mediastinal staging can be achieved with a variety of techniques that can be discussed and performed by the various specialists in the MDT. Despite a relative paucity of quality evidence that MDT contributes to improvements in lung cancer survival outcomes, this approach has evolved to become the standard of care in many centers around the world. Thoracic MDT has resulted in more focused and timely investigations for histopathologic diagnosis and disease staging which translate into earlier treatment initiation. Moreover, there is increasing evidence that MDT care facilitates and allows access to investigations that lead to improved accuracy of tumor and nodal staging. However, there is still a paucity of evidence on the accuracy of lung cancer staging in the MDT setting.
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PMID:Accuracy of lung cancer staging in the multidisciplinary team setting. 3295 39


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