Radical systematic mediastinal lymphadenectomy in non-small cell lung cancer: A randomized controlled trial

Abstract

The value of radical systematic lymphadenectomy in the treatment of bronchial carcinoma is controversial. In a randomized controlled clinical trial, radical lymphadenectomy was compared with conventional node dissection in 182 patients with non-small cell lung cancer. Comparison of short-term results revealed a sigdflcantly longer operating time in those undergoing systematic lymphadenectomy, but overall morbidity and mortality rates were comparable between groups. However, there were compli-The only treatment with a chance of cure for patients with localized non-small cell lung cancer is a radical operation such as classical lobectomy or pneumonectomy. To what extent lymphadenectomy contributes to the chance of cure remains controversial.Some authors' ' advocate radical systematic mediastinal lymphadenectomy as a conditio sine qua non; it is even claimed3s4 that pulmonary resection without mediastinal lymph node dissection has to be considered a palliative operation, denying the patient a chance of cure. In some centres this treatment policy has led to ultraradical operations, mostly in left-sided lung cancers, where bilateral mediastinal lymphadenectomy via a median sternotomy is combined with the classical tumour operation3s5. Other surgeons, such as those of the American Lung Cancer Study Group, have advocated nodal sampling onlyG8 to avoid increasing the morbidity and mortality rates because of the extent of operation. A firm rational basis for extensive systematic lymph node dissection of the ipsilateral thoracic cavity does not emerge from the literat~re~.'~. Benefit has been shown only against historical controls or patients who were excluded from the treatment for other medical reasons3. Since it is unclear which patient categories will benefit from this extensive operation, McKneallyg has emphasized the need for a randomized controlled trial to evaluate the therapeutic efficacy of systematic lymph node dissection. Such a trial was devised to compare the results of conventional lymph node dissection with those of radical systematic lymphadenectomy in patients undergoing curative resection of non-small cell lung cancer. Patients and methodsThe trial was approved by the Ethical Research Committee of the Medical Faculty, University of Munich. Patients were evaluated, randomized, treated and followed up at the Department of Surgery, University of Munich, and the Division of Thoracic Surgery and Department of Pulmonary Medicine, Central Hospital Gauting.Paper accepted 11 July 1993 cations associated with radical lymphadenectomy such as prolonged air leakage and haemorrhage. Interim analysis of results at a median follow-up of 26.8 months showed no significant influence of radical lymphadenectomy on local recurrence-free interval, metastasis-free interval or cancer-related survival. In conclusion, radical systematic lymphadenectomy is a safe operation that leads to a better staging of non-small cell lung cancer, but its prognostic benefit k questionable. Eligibility criteriaPatients of any age and sex with a c...

Mediastinal Lymph-nodes Metastasis beyond the Lobe-specific: An Independent Risk Factor toward Worse Prognoses

“…Major lung resections (either anatomic lobectomy, bi-lobectomies, sleeve lobectomies, or pneumonectomies) combined with radical mediastinal lymphadenectomy were performed for all enrolled cases as noted by Naruke, et al and Izbicki, et al 9,10) All enrolled cases had complete resections, and the resection margins had been verified as negative by on-site frozen section examinations during operations. The final histopathological classification was based on the 1999 World Health Organization guideline.…”

Predictive value of 18F-fluorodeoxyglucose positron emission tomography - computed tomography compared to postoperative pathological findings for patients with non-small-cell lung cancer

“…Lobectomy or pneumonectomy combined with systematic mediastinal lymphadenectomy was successfully performed by experienced thoracic surgeons within 1 week after contrast-enhanced CT and PET-CT imaging, including 92 cases of lobectomy and 14 cases of bilobular lobectomy, as well as 6 cases of pneumonectomy. According to descriptions by Naruke et al (9), Martini and Flehinger (10) and Izbicki et al (11), systematic mediastinal lymphadenectomy was defined as removal of levels 2-4, 7-9 and 10-12 during a right thoracotomy and levels 2-9 and 10-12 during a left thoracotomy.…”

The necessity of mediastinal lymph node resection for screen-diagnosed non-small cell lung cancer (NSCLC) manifesting as subsolid nodule

“…The necessity of mediastinal lymph node resection for screendiagnosed non-small cell lung cancer (NSCLC) manifesting as subsolid nodule stump, chyle leaks, longer operative time, chest tube drainage, and nerve injury (6,7). Due to such dichotomous nature of MLNR, clinicians have always needed to balance the benefits and risks of performing parenchymal resection with MLNR.…”