Surgery for non-small cell lung cancer: systematic review and meta-analysis of randomised controlled trials

Abstract

Background: Surgery is considered the treatment of choice for patients with resectable stage I and II (and some patients with stage IIIA) non-small cell lung cancer (NSCLC), but there have been no previously published systematic reviews. Methods: A systematic review and meta-analysis of randomised controlled trials was conducted to determine whether surgical resection improves disease specific mortality in patients with stages I-IIIA NSCLC compared with non-surgical treatment, and to compare the efficacy of different surgical approaches. Results: Eleven trials were included. No studies had untreated control groups. In a pooled analysis of three trials, 4 year survival was superior in patients undergoing resection with stage I-IIIA NSCLC who had complete mediastinal lymph node dissection compared with lymph node sampling (hazard ratio estimated at 0.78 (95% CI 0.65 to 0.93)). Another trial reported an increased rate of local recurrence in patients with stage I NSCLC treated with limited resection compared with lobectomy. One small study reported a survival advantage among patients with stage IIIA NSCLC treated with chemotherapy followed by surgery compared with chemotherapy followed by radiotherapy. No other trials reported significant improvements in survival after surgery compared with non-surgical treatment. Conclusion: It is difficult to draw conclusions about the efficacy of surgery for locoregional NSCLC because of the small number of participants studied and methodological weaknesses of the trials. However, current evidence suggests that complete mediastinal lymph node dissection is associated with improved survival compared with node sampling in patients with stage I-IIIA NSCLC undergoing resection.

Significance and Mechanism of Lymph Node Metastasis in Cancer Progression

“…Similar situations have been reported for lung cancer (21), endometrial cancer (22), and esophageal cancer (23,24). In stage I-IIIA nonsmall cell lung cancer, a meta-analysis of randomized controlled trials suggests that complete mediastinal LN dissection is associated with improved survival (21). In endometrial cancer, comparative cohort study reports that paraaortic LN dissection (PAND) has survival benefits, and that pelvic LN dissection alone might be an insufficient surgical procedure for patients at intermediate or high risk of recurrence (22).…”

Role of18F-FDG PET in Assessment of Response in Non–Small Cell Lung Cancer

“…These options include more aggressive surgical techniques and the use of neoadjuvant radiotherapy and chemotherapy regimens before surgery (7). There are also adjuvant therapies for patients in whom there is known or suspected incomplete resection.…”

Exérèse chirurgicale des métastases pulmonaires de cancer colorectal : quelle stratégie en 2014 ?

“…Actuellement, ce curage ganglionnaire est validé et reconnu comme essentiel dans la chirurgie d'exérèse initiale du cancer pulmonaire [11][12][13][14][15][16], mais aussi pour d'autres cancers tels que le cancer du sein et le cancer colorectal. Actuellement, la place du curage ganglionnaire pour les métastases de cancers colorectaux tend à se généraliser et devient de moins en moins controversée dans cette indication.…”