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Appropriate Extent of Lymphadenectomy in Segmentectomy: A Multicenter Study
Yoshinori Handa1, Yasuhiro Tsutani1, Takahiro Mimae1
1Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Japanese Journal of Clinical Oncology
|November 18, 2020
Summary
Mediastinal lymph node dissection (LND) in lung cancer segmentectomy may offer better pathological staging and potentially improved survival outcomes compared to hilar LND. Further research is warranted to confirm these findings for lung cancer patients.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- The role of lymphadenectomy in segmentectomy for lung cancer requires further investigation.
- Comparing oncological outcomes of mediastinal lymph node dissection (LND) versus hilar LND in segmentectomy is crucial.
Purpose of the Study:
- To compare the oncological outcomes of mediastinal LND and hilar LND in lung cancer patients undergoing segmentectomy.
- To evaluate the impact of lymphadenectomy extent on survival and recurrence rates.
Main Methods:
- A multicenter database was used for propensity score-matched analysis of 357 clinical stage IA solid-dominant lung cancer patients.
- Patients underwent segmentectomy with either mediastinal LND (n=179) or hilar LND only (n=178).
- Outcomes were analyzed for all patients and matched pairs.
Main Results:
- In propensity score-matched analysis (129 pairs), mediastinal LND harvested more lymph nodes and provided more accurate pathological staging (P=0.015).
- While not statistically significant in all cohorts, the mediastinal LND group showed a trend towards better prognosis (5-year CSS: 97.4% vs 93.2%; 5-year RFI: 93.5% vs 88.5%).
- Adjuvant chemotherapy was more frequent in the mediastinal LND group (7.8% vs 3.1%).
Conclusions:
- Mediastinal LND offers more appropriate pathological staging in segmentectomy for lung cancer due to increased lymph node yield.
- Mediastinal LND may potentially lead to superior oncological outcomes compared to hilar LND in segmentectomy patients.
