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Eur J Cardiothorac Surg 2005;27:680-685
© 2005 Elsevier Science NL

Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer?

Christophe Doddolia,e,*, Adrian Aragona, Fabrice Barlesib, Bruno Chetaillec, Stéphane Robitaild, Roger Giudicellia, Pierre Fuentesa, Pascal Thomasa,e

a Department of Thoracic Surgery, Faculty of Medicine, Université de la Méditerranée (Aix-Marseille II), Sainte-Marguerite Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille Cedex, France
b Department of Thoracic Oncology, Sainte-Marguerite Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille Cedex, France
c Department of Pathology, Sainte-Marguerite Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille Cedex, France
d Department of Medical Information and Biostatistics, Sainte-Marguerite Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille Cedex, France
e UPRES EA 2201, IFR Jean Roche, Marseille Cedex, France

Received 25 August 2004; received in revised form 30 November 2004; accepted 17 December 2004.

* Corresponding author. Address: Sainte-Marguerite Hospital, 270, Bd de Sainte-Marguerite, 13274 Marseille Cedex 09, France. Tel.: +33 491 74 47 41; fax: +33 491 74 45 90. (E-mail: christophe.doddoli{at}mail.ap-hm.fr).

Objective: To assess the therapeutic effect of the extent of lymph node dissection performed in patients with a stage pI non-small-cell lung cancer (NSCLC). Methods: We analysed data on 465 patients with stage I NSCLC who were treated with surgical resection and some form of lymph node sampling. The median number of lymph node sampled was 10 and the median number of ipsilateral mediastinal lymph node stations sampled was two. We chose to define a procedure that harvested 10 or more lymph nodes and sampled two or more ipsilateral mediastinal stations as a lymphadenectomy, by contrast with sampling when one or both criteria were not satisfied. The effect of the surgical techniques: lymph node sampling (LS; n=207) vs. lymphadenectomy (LA; n=258) on 30-day mortality and overall survival were investigated. Results: A total of 6244 lymph nodes was examined, including 4306 mediastinal lymph nodes. The mean (±SD) numbers of removed lymph nodes were 7±6.1 per patient following LS vs.18.6±9.3 following LA (P=0.001). An average mean of 1±0.90 mediastinal lymph node station per patient was sampled following LS vs. 2.7±0.8 following LA (P<10–6). Overall 30-day mortality rates were 2.4 and 3.1%, respectively. LA was disclosed as a favourable prognosticator at multivariate analysis (Hazard Risk: 1.43; 95% Confidence Interval: 1.00–2.04; P=0.048), together with younger patient age, absence of blood vessels invasion, and smaller tumour size. Conclusions: Importance of lymph node dissection affects patients outcome, while it does not enhance the operative mortality. A minimum of 10 lymph nodes assessed, and two mediastinal stations sampled are suggested as possible pragmatic markers of the quality of lymphadenectomy.

Key Words: Non-small-cell lung cancer • Mediastinal lymph nodal sampling • Lymphadenectomy • Prognosis • Multivariate analysis




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