Effect Of Systematic Lymph Node Dissection And Sampling On The Short-term Effect Of Patients With Stage Ⅰ NSCLC Thoracoscopic Radical Lobectomy

ObjectiveThis study retrospectively analyzed the clinical data of patients with stage I non-small cell lung cancer(NSCLC)who underwent thoracoscopic radical lobectomy and lymph node dissection,compared the clinical effects of systematic lymph node dissection group(SND)and lymph node sampling group(NS),and analyzed the risk factors affecting survival,so as to provide theoretical basis for selecting the best way of lymph node dissection in stage I NSCLC.MethodA total of 106 patients with stage I non-small cell lung cancer(NSCLC)who underwent thoracoscopic radical lobectomy and lymph node dissection in the Department of Thoracic surgery,General Hospital of Wanbei Coal and Power Group from September 2019 to June 2022 were included.According to the different methods of lymph node resection during operation,the patients were divided into SND group and NS group.There were 46 cases(43.4%)in SND group and 60 cases(56.6%)in NS group.The clinical efficacy,laboratory data,perioperative indexes,postoperative complications,recurrence and metastasis and long-term survival between the two groups were analyzed,and the risk factors affecting progression-free survival(PFS)and total survival(OS)were discussed.ResultsA total of 106 patients with stage I NSCLC who underwent thoracoscopic radical lobectomy were included in this study,including 50(47.2%)males and 56(52.8%)females,with a median age of 62(55,69)years.Pathological types:there were 90 cases of adenocarcinoma(84.9%),11 cases of squamous cell carcinoma(10.4%),and 5 cases(4.7%)of other types including large cell carcinoma,adenosquamous carcinoma,sarcomatoid carcinoma,epitheliomatoid carcinoma and mucoepidermoid carcinoma.There were significant differences in operation time,lesion diameter,number of lymph node dissection,pathological type and tumor stage between the two groups(P<0.05).There were no significant differences in sex,age,perioperative indexes(intraoperative blood loss,total chest drainage 3 days after operation,postoperative extubation time,postoperative hospital stay),tumor location and postoperative complications between the two groups(P>0.05).The median follow-up time was 21.5 months.There was no significant difference in recurrence rate between SND group and NS group(P>0.05).Survival analysis showed no significant difference in 2-year PFS between SND group and NS group(P=0.262).Univariate survival analysis showed that lesion diameter>1.8cm and intratracheal dissemination reduced PFS(P<0.05).Further multivariate survival analysis showed that lesion diameter>1.8cm and intratracheal dissemination were independent risk factors for PFS(P<0.05).Conclusion1.Both SND and NS can achieve better short-term effect in patients with stage ⅠNSCLC.2.NS is recommended for stage I NSCLC patients with pure ground glass composition,and SND is recommended for stage I NSCLC patients with subsolid or subsolid components.3.Lesion diameter>1.8cm and airway dissemination are independent risk factors for reducing PFS in patients with stage I NSCLC.