Curative-Intention Surgery with Lobe-Specific Versus Systematic Lymph Node Dissection in Clinical Stage IA–IB Non-Small Cell Lung Cancer: Our Experience and Literature Review

TL;DR

This study compares two types of lymph node dissection in early-stage lung cancer, finding similar survival rates but fewer complications with the lobe-specific approach.

Contribution

The study provides focused evidence on lobe-specific lymph node dissection in clinical stage IA–IB NSCLC, addressing a gap in prior reviews.

Findings

LS-LND showed comparable or slightly better 5-year overall survival than S-LND.

Postoperative complications like arrhythmias were less frequent with LS-LND.

Findings from the institutional cohort aligned with broader literature trends.

Abstract

Background and Objectives: The benefit of lobe-specific lymph node dissection (LS-LND) in non-small cell lung cancer (NSCLC) remains debated, especially in early-stage disease. Previous reviews often included all stages, leaving a gap in focused evaluations of clinical stage IA–IB NSCLC. This systematic review, supplemented by our institutional experience, aimed to compare overall survival (OS), recurrence-free survival (RFS), and postoperative complications between LS-LND and systematic lymph node dissection (S-LND) in clinical stage IA–IB NSCLC. Methods: We retrospectively reviewed 24 patients treated at our institution (14 S-LND vs. 10 LS-LND). Data on patient demographics, operative details, OS, RFS, and postoperative complications were collected. Risk of bias was assessed using established methodological tools. A targeted literature search was conducted in PubMed, EMBASE, and Web of Science from inception to 14 April 2022. Only three articles (total n = 1101 patients) met inclusion criteria focusing on clinical stage IA–IB NSCLC who underwent curative-intent resection. Results: LS-LND demonstrated comparable or slightly improved 5-year OS (range: 69.7–96.7%) versus S-LND (64.9–92.0%), and similar or slightly higher RFS (66.0–95.6% in LS-LND vs. 60.8–88.8% in S-LND). In our cohort, the 5-year OS was 78.6% in S-LND vs. 80.0% in LS-LND, and the 5-year RFS was 71.4% vs. 70.0%, respectively. Postoperative complications such as arrhythmias were less frequent in LS-LND groups overall. Our data showed a low rate of pneumonia in S-LND compared to LS-LND (7.1% vs. 10.0%); however, arrhythmias accounted for 14.3% in S-LND vs. 10.0% in LS-LND). Conclusions: For clinical stage IA–IB NSCLC, LS-LND offers oncologic outcomes that are comparable to S-LND, with a potential for reduced postoperative complications. The findings from our institution align with these trends observed in the literature. While these results suggest potential advantages of lobe-specific approaches, definitive conclusions require further validation through larger, prospective randomized studies to confirm the clinical benefits of LS-LND in early-stage NSCLC.

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