Preoperative computed tomography of the chest in lung cancer patients: the predictive value of calcified lymph nodes for the perioperative outcomes of video-assisted thoracoscopic surgery lobectomy

Jin, Kwang Nam; Moon, Hyeon-Jong; Sung, Yong Won; Lee, Youkyung; Wi, Jae Yeon
December 2013
European Radiology;Dec2013, Vol. 23 Issue 12, p3278
Academic Journal
Objectives: To determine the predictive value of identifying calcified lymph nodes (LNs) for the perioperative outcomes of video-assisted thoracoscopic surgery (VATS). Methods: Fifty-six consecutive patients who underwent VATS lobectomy for lung cancer were included. We evaluated the number and location of calcified LNs on computed tomography (CT). We investigated clinical parameters, including percentage forced expiratory volume in 1 s (FEV 1%), surgery duration, chest tube indwelling duration, and length of hospital stay. We performed linear regression analysis and multiple comparisons of perioperative outcomes. Results: Mean number of calcified LNs per patient was 0.9 (range, 0–6), mostly located in the hilar-interlobar zone (43.8 %). For surgery duration (mean, 5.0 h), FEV 1% and emphysema severity were independent predictors ( P = 0.010 and 0.003, respectively). The number of calcified LNs was an independent predictor for chest tube indwelling duration ( P = 0.030) and length of hospital stay ( P = 0.046). Mean duration of chest tube indwelling and hospital stay was 8.8 days and 12.7 days in no calcified LN group; 9.2 and 13.2 in 1 calcified LN group; 12.8 and 19.7 in ≥2 calcified LNs group, respectively. Conclusions: The presence of calcified LNs on CT can help predict more complicated perioperative course following VATS lobectomy. Key Points: • Preoperative chest CT can help predict perioperative outcome following video-assisted thoracoscopic surgery.• Calcified lymph nodes should be assessed on CT to predict perioperative outcome.• Multiple calcified LNs are associated with longer chest drainage.• Hospital stay appears longer in patients with more calcified lymph nodes.


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