Evaluating the quality of lymphadenectomy in lung cancer resections: a narrative review

Abstract

Objective: To review the current guidelines on intrathoracic lymph node assessment for lung cancer resections, examine current practice patterns, report survival differences with varying levels of lymph node dissection, and propose methods to improve quality of lymphadenectomy based on our experience.Background: Assessment of hilar and mediastinal lymph nodes at the time of resection for lung cancer has been recognized as a key aspect of surgical treatment. Although the value of lymphadenectomy in lung cancer staging and treatment has been established, specific guidelines as to the number and location of lymph nodes considered to be adequate, vary among societies, institutions, and surgeons. Additionally, many lung resections fail to meet any of the proposed criteria for lymph node examination.Methods: To find relevant articles for the narrative review, the PubMed database was used to search for the following key terms and their combinations: "lymphadenectomy", "lymph node staging", "lung cancer", "NSCLC", "lung surgery", "lung resection", "lobectomy", "segmentectomy", "wedge resection", "quality", and "extent". A total of 33 articles were examined and publication years ranged from 1951 to 2021.Conclusions: Systematic mediastinal lymph node dissection is recommended in all type of surgeries for lung cancer, whether robotic surgery, video-assisted thoracoscopic surgery (VATS), or an open thoracotomy.There should be no difference in each technique as to the number of stations and quantity of lymph nodes examined, in order for lung cancer resection to be considered complete.

Influencing Factors on the Quality of Lymph Node Dissection for Stage IA Non-Small Cell Lung Cancer: A Retrospective Nationwide Cohort Study

“…Despite the evidence, intraoperative nodal assessment very often falls short of recommendations [23]. In a study by Ray et al, only 18% of patients operated on for early-stage NSCLC had any type of MLND, and 6% had nodal sampling.…”