Appropriate lymphadenectomy significantly reduced recurrence after segmentectomy for patients with non-small cell lung cancer

Abstract

Background: Segmentectomy has been widely used for small-sized non-small cell lung cancer (NSCLC).The objective of this study is to determine the impact of number of harvested lymph nodes (LNs) on survival for patients undergoing segmentectomy. Methods: The clinicopathologic data of patients undergoing segmentectomy for NSCLC from July 2011 to December 2014 were retrospectively analyzed. Survival analysis was performed by Kaplan-Meier method and Cox regression analysis. Results: A total of 259 patients with NSCLC were eligible for analysis. Patients with harvested LN ≥6 had higher frequency of nodal metastasis in pathologic examination (9.4% vs. 1.5%, P=0.005). The 3-year recurrence-free survival (RFS) of patients with harvested LN ≥6 (90.2%) was significantly higher than that of patients with harvested LN <6 (73.7%, log-rank P=0.038). Multivariable Cox analysis identified harvested LN ≥6 as an independent predictor for improved RFS [hazard ratio (HR) =0.35; 95% confidence interval (CI): 0.14-0.90; P=0.029]. There was no significant difference in RFS between patients with harvested LN station ≥3 and <3 (log-rank P=0.34). Conclusions: The number of harvest LN ≥6 was independently associated with improved RFS for NSCLC patients undergoing segmentectomy, supporting the National Comprehensive Cancer Network (NCCN) guidelines of appropriate LN sampling.

Strategies of Lymph Node Dissection During Sublobar Resection for Early-Stage Lung Cancer

“…One can even say that the level of exigency should be even higher because of the potential for overlooking iLNs. This leads us to make the following recommendations, which are not our own but those inspired by surgeons and expert centers that have been cited in this article ( 11 , 17 , 18 , 23 , 26 , 27 , 29 , 40 ):…”

“…In 259 patients who underwent segmentectomy for NSCLC, Huang et al showed that when patients had more than 6 nodes examined, the rate of diagnosed lymph node metastases was significantly higher (9.4 vs. 1.5%, p = 0.005) and 5-year survival was significantly higher ( 27 ). In Yendamuri's series of 3,916 patients operated on for stage I NSCLC by SLR, the only prognostic factor in multivariate analysis for 5-year survival was the number of nodes examined, while the extent of resection did not have a significant influence ( 28 ).…”

Thoracoscopic complex basilar segmentectomies: an analysis of 63 procedures

“…In addition, some patients who had no intersegmental lymph node clearance can be understaged and do not benefit from an adjuvant treatment. (22).…”

Should lobectomy still be considered the treatment of choice for stage IA non-small cell lung cancer?

“…A more recent comparative study has shown an increased risk of recurrence in patients undergoing sublobar resection compared to patients who underwent lobectomy (8). An argument that has been suggested to explain this result is that the lymphadenectomy during such operations is frequently insufficient, although it is widely demonstrated that an inadequate lymphadenectomy is a major factor for recurrence (9).…”