Choice Of Surgery For Completely Resected Non-small Cell Lung Cancer: Mediastinal Lymph Node Dissection And Lymph Node Sampling

Background:Although surgery is still considered a standard treatment for early stage non-small cell lung cancer (NSCLC), the removal extent of mediastinal lymph nodes in patients with completely resected cancer mass is still controversial.Methods:In our study, we performed a meta-analysis of available studies published in English between 1990 and 2010 with regard to the mortality, morbidity, recurrence rates and overall survival of patients with resectable NSCLC received different extents of lymphadenectomy.Results:Six clinical trials including a total of 2251 patients met the defined criteria. As a comparison for lymph node dissection (LND) and lymph node sampling (LNS), the risk ratio for postoperative mortality was 0.53(95%confidence interval (CI):0.22-1.26), and for postoperative morbidity 1.22(95% CI:0.90-1.66). And the pooled risk rates of local, distant and overall recurrence rate were 0.73(95% CI: 0.55-0.97); 0.92, (95%CI:0.78-1.08); 0.88, (95%CI:0.79-0.98) respectively. Also, the estimated combined hazard ratio for overall survival in six studies was 0.89 (95% CI:0.64-1.24) which showed no advantages in patients underwent LND. Conclusions:Lobectomy (pneumonectomy) combined with LND is a safe surgical procedure because it doesnot increase the rate of postoperative mortality and postoperative morbidity. LND doesn't offer a better overall survival compared with LNS though it can decrease the rate of local and overall recurrence rate.