Omitting Lymph Node Dissection for Small Ground-Glass Opacity-Dominant Tumors.

Area of Science:

• Thoracic Surgery
• Oncology
• Pulmonary Medicine

Background:

• Small (≤3 cm) peripheral non-small cell lung cancers (NSCLC) with ground-glass opacity (GGO) require optimal lymph node dissection strategies.
• Determining the extent of lymph node dissection is crucial for balancing oncologic outcomes and surgical morbidity in these specific NSCLC subtypes.

Purpose of the Study:

• To ascertain the necessary extent of lymph node dissection for patients presenting with small, GGO-dominant, peripheral NSCLC.
• To evaluate the impact of different surgical resection methods on patient outcomes.

Main Methods:

• Analysis of clinicopathologic data and surgical outcomes from 988 patients with GGO-dominant NSCLC who underwent complete primary tumor resection (2010-2020).
• Median follow-up of 54.5 months.
• Kaplan-Meier curves and log-rank tests were employed for prognostic statistical analysis.

Main Results:

• The study included 988 patients (60% female, median age 68 years) with small tumors (median size 1.7 cm).
• Adenocarcinoma comprised 99% of tumors. Excellent 5-year overall survival of 96.5% was observed, irrespective of surgical procedure (wedge resection, segmentectomy, or lobectomy).
• Only one patient had hilar lymph node involvement, with no mediastinal metastasis or recurrence detected.

Conclusions:

• Lymph node dissection may be omitted in select cases of small, GGO-dominant lung tumors intended for curative resection.
• Procedures like wedge resection, segmentectomy, or lobectomy, when performed with secure surgical margins, yield satisfactory outcomes for indolent NSCLC.
• These findings suggest a less invasive approach may be feasible for specific early-stage lung cancer presentations.