Chenglin Guo1,2, Liang Xia1,2, Jiandong Mei1,2, Chengwu Liu1,2, Feng Lin1,2, Lin Ma1,2, Qiang Pu1,2, Lunxu Liu1,2. 1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China. 2. Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu 610041, China.
Abstract
BACKGROUND: The aim of our study was to compare the efficacy of lymph node (LN) dissection, short-term surgical outcomes, and long-term outcomes between non-grasping en bloc mediastinal lymph node dissection (NE-MLND) and traditional grasping mediastinal lymph node dissection (G-MLND) under video-assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC). METHODS: We retrospectively analyzed 872 patients with pathological stage I-III NSCLC who underwent VATS. The patient's demographic characteristics, short-term surgical outcomes, overall survival (OS) and disease-free survival (DFS) were assessed. A propensity score-matched (PSM) analysis was performed between NE-MLND and G-MLND to reduce bias, and 349 pairs of patients were matched. RESULTS: Before propensity-score matching, for short-term surgical outcomes, the NE-MLND group had shorter operation time (P<0.001), more LNs removed (N1: P=0.002; N2: P<0.001; N1+N2: P<0.001), more pleural drainage during the first 3 days after surgery (P<0.001), and longer postoperative hospital stay (P<0.001). For long-term survival outcomes, the NE-MLND group had a longer OS (5-year OS: 71.8% vs. 64.8%, P=0.013), and there was no difference in DFS between the 2 groups (P=0.138). After propensity-score matching, the short-term surgical outcomes were consistent with the results before PSM. The OS and DFS in NE-MLND group were significantly longer than those in the G-MLND group (5-year OS: 76.4% vs. 63.5%, P=0.001 and 5-year DFS: 63.0% vs. 54.6%, P=0.033, respectively). Multivariate analysis showed that NE-MLND was an independent protective factor against OS [G-MLND: hazard ratio (HR) 1.461; 95% confidence interval (CI), 1.130-1.890; P=0.004]. CONCLUSIONS: NE-MLND is a safe, acceptable and superior approach to remove mediastinal LNs with shorter operation time. Patients with NSCLC may benefit from NE-MLND, which could lead to better OS and DFS as compared with G-MLND.
BACKGROUND: The aim of our study was to compare the efficacy of lymph node (LN) dissection, short-term surgical outcomes, and long-term outcomes between non-grasping en bloc mediastinal lymph node dissection (NE-MLND) and traditional grasping mediastinal lymph node dissection (G-MLND) under video-assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC). METHODS: We retrospectively analyzed 872 patients with pathological stage I-III NSCLC who underwent VATS. The patient's demographic characteristics, short-term surgical outcomes, overall survival (OS) and disease-free survival (DFS) were assessed. A propensity score-matched (PSM) analysis was performed between NE-MLND and G-MLND to reduce bias, and 349 pairs of patients were matched. RESULTS: Before propensity-score matching, for short-term surgical outcomes, the NE-MLND group had shorter operation time (P<0.001), more LNs removed (N1: P=0.002; N2: P<0.001; N1+N2: P<0.001), more pleural drainage during the first 3 days after surgery (P<0.001), and longer postoperative hospital stay (P<0.001). For long-term survival outcomes, the NE-MLND group had a longer OS (5-year OS: 71.8% vs. 64.8%, P=0.013), and there was no difference in DFS between the 2 groups (P=0.138). After propensity-score matching, the short-term surgical outcomes were consistent with the results before PSM. The OS and DFS in NE-MLND group were significantly longer than those in the G-MLND group (5-year OS: 76.4% vs. 63.5%, P=0.001 and 5-year DFS: 63.0% vs. 54.6%, P=0.033, respectively). Multivariate analysis showed that NE-MLND was an independent protective factor against OS [G-MLND: hazard ratio (HR) 1.461; 95% confidence interval (CI), 1.130-1.890; P=0.004]. CONCLUSIONS: NE-MLND is a safe, acceptable and superior approach to remove mediastinal LNs with shorter operation time. Patients with NSCLC may benefit from NE-MLND, which could lead to better OS and DFS as compared with G-MLND.
Entities:
Keywords:
Non-grasping; en bloc; mediastinal lymph node dissection (MLND); non-small cell lung cancer (NSCLC); video-assisted thoracic surgery (VATS)
Authors: Jonathan D'Cunha; James E Herndon; Debra L Herzan; G Alexander Patterson; Leslie J Kohman; David H Harpole; Kemp H Kernstine; Jeffrey A Kern; Mark R Green; Michael A Maddaus; Robert A Kratzke Journal: Lung Cancer Date: 2005-01-04 Impact factor: 5.705
Authors: Ahmedin Jemal; Freddie Bray; Melissa M Center; Jacques Ferlay; Elizabeth Ward; David Forman Journal: CA Cancer J Clin Date: 2011-02-04 Impact factor: 508.702