Selective mediastinal lymphadenectomy for clinico-surgical stage I non-small cell lung cancer

Background. Improved radiologic imaging provides earlier detection of non-small cell lung cancer, but controversy exists regarding the need for complete lymph node dissection. This study was designed to evaluate the possibility of lesser mediastinal dissection for early-stage lung cancer. Methods. Selective mediastinal dissection is defined as follows: Dissection of the upper mediastinum for upper-lobe tumors is performed but it is not needed for lower-lobe tumors with intact hilar and lower mediastinal nodes. Also, dissection of the lower mediastinum for an upper-lobe tumor is not routinely required when the nodes in the hilum and upper mediastinum are negative. From 1997 through 2002, 377 patients with clinico-surgical stage I non-small cell lung cancer underwent curative-intent surgery with selective dissection (group S). In addition, 358 patients with the same-stage disease who underwent complete lymphadenectomy by the same surgical team served as historic controls (group C). Results. The characteristics of the two groups were well balanced. There was no significant difference in disease-free survival (p = 0.376) or overall survival (p = 0.060). Multivariate analysis showed that the dissection mode did not significantly influence either disease-free survival (p = 0.636) or overall survival (p = 0.119). The postoperative morbidity rates were 17.3% and 10.1% for group C and group S, respectively (p = 0.005). One operative death occurred in each group (0.3%). The rates of distant metastasis and local recurrence were similar in the two groups. Conclusions. Selective mediastinal dissection for clinico-surgical stage I non-small cell lung cancer proved to be as effective as complete dissection, and although large multicenter trials are warranted, it might be considered as an alternative for curative surgery in this era of minimally invasive surgery.