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The prognostic value of 4L lymph node dissection in left-side operable non-small-cell lung cancer: a meta-analysis

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Abstract

The prognostic value of 4L lymph node dissection (4L-LND) continues to be controversial. We conducted this systematic review and meta-analysis to evaluate the prognosis of 4L-LND in operable non-small-cell lung cancer (NSCLC) patients. We systematically searched studies from PubMed, Embase, and the Cochrane Library up to May 1, 2023. Studies investigating the prognostic value of 4L-LND and non-4L-LND in NSCLC survival were included. Data for analysis mainly comprised postoperative complications, overall survival (OS), and disease-free survival (DFS). The Q-test and I2-test were used to assess heterogeneity. The stability of pooled hazard ratios (HRs) was examined by sensitivity analysis. Six retrospective studies with a total of 4565 NSCLC patients who received 4L-LND or did not receive 4L-LND were considered. The 4L-LND group had significantly better OS (HR = 0.75, 95% CI 0.61–0.91, P = 0.004) and DFS (HR = 0.76, 95% CI 0.66–0.88, P = 0.0002) than the non-4L-LND group, especially in the subgroup analysis of propensity score matching studies. Although no significant difference in the rate of chest tube drainage for more than 7 days (risk ratio (RR) = 0.98, 95% CI 0.31–3.08, P = 0.97), hoarseness rate (RR = 1.60, 95% CI 0.53–4.87, P = 0.51), and chylothorax rate (RR = 1.28, 95% CI 0.58–2.84, P = 0.54) was observed, those who received 4L-LND had a higher total postoperative complication rate than those who did not (RR = 1.35, 95% CI 1.09–1.67, P = 0.006). No significant heterogeneity existed during our analysis, and no potential publication bias was observed among these studies. Our meta-analysis showed that the 4L-LND group was significantly associated with both survival outcomes and postoperative complications compared with the non-4L-LND group in treating NSCLC patients. However, further prospective clinical trials should be designed to evaluate our conclusion owing to the lack of guideline support.

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Author notes

  1. Lei Peng, Kai-Li Huang and Qian-Wen Shang contributed equally to the paper and shared the co-first authorship.

Authors and Affiliations

  1. Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China

    Lei Peng, Kai-Li Huang & Yun Wang

  2. Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Kai-Li Huang & Wen Li

  3. Lung Cancer Center, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China

    Wen Li

  4. Department of Clinical Lab, Chongqing University Cancer Hospital and Chongqing Cancer Hospital, Chongqing, China

    Qian-Wen Shang

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  1. Lei Peng
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Correspondence to Yun Wang or Wen Li.

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Peng, L., Huang, KL., Shang, QW. et al. The prognostic value of 4L lymph node dissection in left-side operable non-small-cell lung cancer: a meta-analysis. Updates Surg 76, 23–32 (2024). https://doi.org/10.1007/s13304-023-01694-2

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  • DOI: https://doi.org/10.1007/s13304-023-01694-2

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