Omitting of Lymphadenectomy is Acceptable for Lung Cancer Smaller Than 6 mm in Solid Size

Liang Chen

Status: Completed

Conditions: Non-small Cell Lung Cancer

Treatments: Other: No intervention

Study type: Observational

Funder types: Other

Identifiers

NCT06516796

2022-SR-760

Details and patient eligibility

About

Many studies suggested that selective lymph node sampling was acceptable for specific non-small cell lung cancer (NSCLC). This study aimed to evaluate the acceptability of omitting of lymphadenectomy for selected NSCLC.

Patients with small-sized (≤2 cm) NSCLC who underwent surgical resection between 2009 and 2022 were retrospectively screened.

Full description

Many studies suggested that selective lymph node sampling was acceptable for specific non-small cell lung cancer (NSCLC). This study aimed to evaluate the acceptability of omitting of lymphadenectomy for selected NSCLC.

Patients with small-sized (≤2 cm) NSCLC who underwent surgical resection between 2009 and 2022 were retrospectively screened. The characteristics of patients with nodal metastasis were demonstrated. For selected patients, the perioperative and long-term outcomes of patients with and without lymphadenectomy were compared. Log-rank test and Cox regression analysis were adopted for prognostic evaluation.

A total of 2713 NSCLC patients were enrolled, and 75 of them (2.76%) had nodal involvement. None of patients with pure ground glass opacity (0/945) had nodal metastasis, while 14 patients with part-solid (14/1260, 1.11%) and 61 patients with solid nodules (61/508, 12.01%) had nodal involvement. Patients with nodal metastasis had a minimum solid size of 6 mm. NSCLC with solid components < 6 mm (n=1588) had no nodal metastasis. Of them, 339 patients underwent sublobar resection without lymphadenectomy (SRN0), 1056 subjects received sublobar resection with lymphadenectomy (SRN1), and 190 patients received lobectomy plus lymphadenectomy (LRN1). Patients with SRN0 had a shorter operating time, less volume of drainage, a lower incidence of chylothorax (0 vs. 0.6% vs. 2.1%, P=0.012) and air leakage, as well as a shorter postoperative hospitalization (3 vs. 4 vs. 4 days, P<0.001) than those with SRN1 or LRN1. During a median follow-up of 61 months, no patient with SRN0 was dead or tumor recurrent. The 5-year recurrence-free survival was 100%, 99.2% and 98.5% for patients with SRN0, SRN1 and LRN1, respectively (P=0.370).

Enrollment: 2,713 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• pathologically confirmed non-small cell lung cancer (NSCLC)
• the maximum tumor diameter ≤2 cm
• receiving surgical treatment between 2009-2022

Exclusion criteria

• non-primary NSCLC;
• with small cell lung cancer components;
• undergoing preoperative neoadjuvant therapies;
• with compromised resection;
• malignant tumor history over the past five years.

Trial design

2,713 participants in 3 patient groups

sublobar resection without lymphadenectomy

Description:

Patients received sublobar resection but had no lymphadenectomy

Treatment:

Other: No intervention

sublobar resection with lymphadenectomy

Description:

Patients received sublobar resection plus lymphadenectomy

Treatment:

Other: No intervention

lobectomy plus lymphadenectomy

Description:

Patients received lobectomy plus lymphadenectomy

Treatment:

Other: No intervention