Lobe-Specific Versus Systematic Lymph Node Dissection in Clinical Stage I Non-Small Cell Lung Cancer: A Propensity
Hirotsugu Notsuda1, Ken Onodera1, Sakiko Kumata1
1Department of Thoracic Surgery, Tohoku University Hospital, Sendai, Miyagi, Japan.
Background:
The optimal extent of lymph node dissection (LND) in early-stage non-small cell lung cancer (NSCLC) remains controversial. This study aimed to compare perioperative and oncological outcomes between lobe-specific LND (LSD) and systematic LND (SND) in patients with clinical stage I NSCLC based on the 8th edition of the TNM classification.
Methods:
We retrospectively analyzed 390 patients with clinical stage I NSCLC who underwent lobectomy with LND between 2010 and 2020. Patients with tumors in the right middle lobe or left lingular segment were excluded. Propensity score matching (PSM; 1:1 nearest-neighbor matching) was performed using clinical and radiological covariates, yielding 140 matched patients in each group. Perioperative outcomes, postoperative complications (Clavien-Dindo grade ≥ II, with postoperative pneumonitis assessed according to CTCAE version 5.0), overall survival (OS), relapse-free survival (RFS), and recurrence patterns were compared.
Results:
After PSM, the LSD group had significantly shorter operative time, less blood loss, and shorter durations of chest tube placement and postoperative hospital stay than the SND group (all p < 0.05). Postoperative supraventricular tachyarrhythmia occurred more frequently in the SND group (0.7% vs. 7.1%, p = 0.006), whereas other complications were comparable. There were no significant differences in OS or RFS before or after PSM. Recurrence rates and patterns, including ipsilateral lymph node recurrence, were comparable.
Conclusions:
LSD appears to be an oncologically valid and less invasive alternative to SND in patients with clinical stage I NSCLC. LSD may reduce surgical invasiveness and postoperative morbidity without compromising survival or increasing the risk of recurrence.
