Improvement of surgical techniques such as parenchymal-sparing resection, development of more effective chemotherapy regimens, and significantly increased long-term survival as observed in retrospective studies have resulted in pulmonary metastasectomy gradually becoming a standard therapeutic procedure in properly selected patients. However, surgical resection of pulmonary metastasis is sometimes necessary for pathological confirmation, and complete surgical excision of all pulmonary deposits is often technically feasible with low morbidity and mortality. Pulmonary metastasis represents terminal systemic disease hence, chemotherapy has been the mainstay of therapeutic intervention in the majority of cases. More than 30% of extra-thoracic malignances give rise to pulmonary metastasis during the course of the disease, and approximately 20% of these cases feature metastases that are confined to the lungs. The lung is one of the most common sites of distant metastasis of solid tumors because the pulmonary arterial vascular bed is the first filter in the hematogenous route. However, further large-volume and multi-institutional studies are needed. SLN identification might be an indicator of whether or not MLND should be performed during pulmonary metastasectomy. Lymph node metastasis was identified in 3 of the 22 patients (13.6%), and none of the 3 patients with N1 or N2 disease had false-negative SLNs. In all patients, the SLN could be detected, and the number of SLNs identified was 2.0 ± 1.15 (range, 1–5) per patient. The number of dissected lymph nodes per patient was 14.4 ± 8.69 (range, 5–36). Lobectomy was performed in 17 patients, and segmentectomy, in 5 patients. During the operation, the radioactivity of the lymph nodes (ex vivo) was counted with a handheld gamma probe after MLND. Radiotracer was administered at the peritumoral region before surgery or soon after initiating surgery. A total of 22 patients (16 men, 6 women age 63.3 ± 7.01 years) who were candidates for metastasectomy through segmentectomy or lobectomy with MLND owing to cancers metastatic to the lung were enrolled in this study. This is the first study to evaluate the feasibility of mediastinal lymph node dissection (MLND) based on sentinel lymph node (SLN) status during pulmonary metastasectomy.
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