Yuzhao Wang1, Nan Wu1, Jinfeng Chen1, Chao Lv1, Shi Yan1, Shaolei Li1, Yinan Liu1, Lijian Zhang1, Yue Yang2. 1. Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, PR China. 2. Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, PR China. Electronic address: zlyangyue@bjmu.edu.cn.
Abstract
BACKGROUND: The extent of lymph node dissection during surgery in elderly non-small-cell lung cancer patients remains controversial. We evaluated a cohort of elderly patients with clinical N0 disease who underwent lobectomy to determine if radical mediastinal lymphadenectomy (RML) is justified for the special group. PATIENTS AND METHODS: A single-center database of patients over 70 y old from 2001-2011 was used to conduct a matched-pair analysis. The patients undergoing RML were matched 1:1 with those not (non-radical mediastinal lymphadenectomy group) by age, gender, American Society of Anesthesia score, histology, and clinical T status to assess their postoperative and long-term outcomes. RESULTS: A total of 136 patients could be matched (68 RML and 68 non-radical mediastinal lymphadenectomy). No statistical difference was observed in postoperative mortality and overall morbidity rate between the matched groups (0 versus 1, P > 0.99 and 43 versus 35, P = 0.17). Patients undergoing RML experienced more major morbidities, but no significant difference was achieved (15 versus 7, P = 0.06). No significantly more N-positive diseases were discovered in RML group (N1 and N2 involvement disease: 16 versus 16, P > 0.99 and 10 versus 4, P = 0.09, respectively). RML was associated with a significantly longer cancer-related and disease-free survival (P = 0.02 and P = 0.02). Whereas for clinical IA diseases, significant differences were observed neither in cancer-related nor in disease-free survival (P = 0.67 and P = 0.61). CONCLUSIONS: The performance of RML seemed to result in a tendency of higher major morbidity rate in elderly patients, but to contribute a favorable impact on long-term survival. However, for clinical IA patients the survival benefits were not obtained.
BACKGROUND: The extent of lymph node dissection during surgery in elderly non-small-cell lung cancerpatients remains controversial. We evaluated a cohort of elderly patients with clinical N0 disease who underwent lobectomy to determine if radical mediastinal lymphadenectomy (RML) is justified for the special group. PATIENTS AND METHODS: A single-center database of patients over 70 y old from 2001-2011 was used to conduct a matched-pair analysis. The patients undergoing RML were matched 1:1 with those not (non-radical mediastinal lymphadenectomy group) by age, gender, American Society of Anesthesia score, histology, and clinical T status to assess their postoperative and long-term outcomes. RESULTS: A total of 136 patients could be matched (68 RML and 68 non-radical mediastinal lymphadenectomy). No statistical difference was observed in postoperative mortality and overall morbidity rate between the matched groups (0 versus 1, P > 0.99 and 43 versus 35, P = 0.17). Patients undergoing RML experienced more major morbidities, but no significant difference was achieved (15 versus 7, P = 0.06). No significantly more N-positive diseases were discovered in RML group (N1 and N2 involvement disease: 16 versus 16, P > 0.99 and 10 versus 4, P = 0.09, respectively). RML was associated with a significantly longer cancer-related and disease-free survival (P = 0.02 and P = 0.02). Whereas for clinical IA diseases, significant differences were observed neither in cancer-related nor in disease-free survival (P = 0.67 and P = 0.61). CONCLUSIONS: The performance of RML seemed to result in a tendency of higher major morbidity rate in elderly patients, but to contribute a favorable impact on long-term survival. However, for clinical IA patients the survival benefits were not obtained.
Authors: Byungjoon Park; Genehee Lee; Hong Kwan Kim; Yong Soo Choi; Jae Il Zo; Young Mog Shim; Jhingook Kim Journal: World J Surg Oncol Date: 2016-01-19 Impact factor: 2.754