Lobe-specific Lymph Node Dissection in Clinical Stage IA Solid-dominant Non–small-cell Lung Cancer: A Propensity Score Matching Study

• Published in: Clinical lung cancer 2021-03, Vol.22 (2), p.e201-e210
• Main Authors: Zhao, Yue, Mao, Yousheng, He, Jie, Gao, Shugeng, Zhang, Zhirong, Ding, Ningning, Xue, Qi, Gao, Yushun, Wang, Dali, Zhao, Jun, Tan, Fengwei, Yuan, Ligong, Li, Feng, Wang, Shuaibo, Yang, Lin
• Format: Article
• Language: English
• Subjects: Adult; Aged; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Clinical stage IA; Disease-Free Survival; Humans; Lobe-specific lymph node dissection; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Node Excision - methods; Lymphatic Metastasis; Male; Middle Aged; Minimally invasive surgery; Minimally Invasive Surgical Procedures; Neoplasm Staging; NSCLC; Pneumonectomy; Postoperative Complications - epidemiology; Propensity Score; Prospective Studies; Recurrence; Survival Rate; Systematic lymph node dissection
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2020.09.012

Lobectomy with systematic lymph node dissection (SND) remains the standard procedure for resectable non–small-cell lung cancer (NSCLC), whereas lobe-specific lymph node dissection (LSND) was reported to have more advantages in perioperative recovery and complication reduction in treating early-stage diseases. Survival outcomes after LSND remains controversial compared with SND. From 2014 to 2017, data of 546 patients with clinical stage IA solid-dominant NSCLC and who underwent curative lobectomies with LSND (n = 100) or SND (n = 446) at our institution were collected. Propensity score matching was conducted to eliminate the biases. Five-year disease-free survival and overall survival were compared between the groups. Perioperative parameters and postoperative complications were also analyzed. Lobectomies with LSND or SND were performed in 100 patients and 446 patients, respectively. After matching, there were 100 patients in each group and no significant differences in 5-year overall survival (P = .473) and disease-free survival (P = .789) were found between the groups. Recurrence patterns were also similar (P = .733). Perioperative parameters were similar, whereas the incidence of postoperative complications in the SND group was found to be significantly higher than that in the LSND group (P = .003). Our study demonstrated that LSND has similar efficiency to SND in terms of survival, recurrence, lymph node dissection, and perioperative recovery of patients with clinical stage IA solid-dominant NSCLC, as well as significant advantages in reducing postoperative complications. Therefore, curative lobectomies with LSND may be more suitable and practical for clinical stage IA solid-dominant patients with NSCLC. Lobectomy with systematic lymph node dissection (SND) remains the standard procedure for resectable non–small-cell lung cancer, whereas, in recent years, lobe-specific lymph node dissection (LSND) has been reported in surgical treatment for early-stage diseases. However, whether LSND is comparable with SND in terms of survival is still controversial. In this cohort of 546 clinical stage IA solid-dominant patients with non–small-cell lung cancer, LSND was demonstrated to have similar recurrence and survival outcomes to SND.