Selective Mediastinal Lymphadenectomy Without Intraoperative Frozen Section Examinations for Clinical Stage I Non-Small-Cell Lung Cancer: Retrospective Study of 403 Cases

• Published in: World journal of surgery 2013-02, Vol.37 (2), p.392-397
• Main Authors: Jiang, Wei, Chen, Xiaoke, Xi, Junjie, Wang, Qun
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Cardiac Surgery; Complete Lymph Node Dissection; Female; Follow-Up Studies; Frozen Sections; General Surgery; Humans; Intraoperative Care - methods; Kaplan-Meier Estimate; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Node Excision - methods; Male; Mediastinal Lymph Node; Mediastinal Lymph Node Dissection; Mediastinal Lymphadenectomy; Mediastinum; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Pneumonectomy - methods; Retrospective Studies; Surgery; Survival Rate; Systematic Lymphadenectomy; Thoracic Surgery; Thoracic Surgery, Video-Assisted; Treatment Outcome; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-012-1849-9

Objective The extent of mediastinal lymphadenectomy for clinical stage I non-small-cell lung cancer (NSCLC) remains controversial. This study explored the value of selective mediastinal lymphadenectomy from the clinical viewpoint. Methods From 2005 to 2008, a total of 403 patients diagnosed clinically as having stage I NSCLC underwent lobectomy and mediastinal lymph node dissection. Among them, 309 underwent complete mediastinal lymphadenectomy, and the other 94 underwent selective mediastinal lymphadenectomy. We compared the perioperative parameters and overall survival statistics for the two groups retrospectively. Results The two groups had no significant differences in sex, pathology, tumor location, or preoperative staging. The selective mediastinal lymphadenectomy group had an older average age, with a much higher rate of patients >70 years of age ( p  = 0.016). Also, the patients were apt to undergo thoracoscopic lobectomy ( p  = 0.044). This group had shorter operating times and less intraoperative bleeding. No significant differences in total drainage volume, length of hospital stay, or complication rates were found between the two groups. The mean follow-up periods were 35.8 ± 13.7 vs. 34.6 ± 17.2 months. Local and distant recurrence rates were 25.6 % vs. 30.9 %, respectively ( p  = 0.560). The 3-year and 5-year overall survival rates were 83.0 % and 74.6 % vs. 75.1 % and 68.5 %, respectively ( p  = 0.216). Conclusions For patients with clinical stage I NSCLC, selective mediastinal lymphadenectomy can reduce the trauma caused by the procedure, especially for elderly patients and those with co-morbidities. Survival was acceptable and was no worse than that after complete mediastinal lymphadenectomy. Our results need to be confirmed by prospective randomized controlled studies.