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Selective Mediastinal Lymphadenectomy or Complete Mediastinal Lymphadenectomy for Clinical Stage I Non-Small Cell Lung Cancer: A Meta-Analysis

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Abstract

Introduction

Selective mediastinal lymphadenectomy (SML) and complete mediastinal lymphadenectomy (CML) are two main types of surgery conducted for the treatment of non-small cell lung cancer (NSCLC) plus lobectomy or segmentectomy. It is not known whether stage I NSCLC can benefit from CML. Using the meta-analytical method, our research aimed to find out the worth of SML and CML for the therapy of clinical stage I NSCLC.

Methods

We searched PubMed, Ovid, MEDLINE, Cochrane Controlled Trial Register (CENTRAL), Embase, and Google Scholar for literature published up to June 2021 to evaluate the comparative research and to assess the post-operative complications, overall survival rate, disease-free survival rate, and local and distant recurrence. This meta-analysis was conducted by combining the results of the reported incidences of post-operative complications, local and distant recurrence, and short- and long-term mortality. The pooled odds ratios (OR) and the 95% confidence intervals were calculated by random or fixed effects models to compare the effectiveness between these two methods.

Results

Five retrospective studies and one randomized controlled trial study were included in our research. The six studies included a total of 5713 patients, of whom 1480 were assigned to the SML group and 4233 were assigned to the CML group. No statistically significant differences were found in the 1- and 5-year overall survival rates or the 1-, 3-, and 5-year disease-free survival rates between the two groups. However, the 3-year overall survival favored the SML group (P < 0.05). There were also no statistically significant differences between the local and distant metastasis. Among the postoperative complications, pneumonia, atelectasis, and prolonged air leak were more common in the CML group (P < 0.05). There were no differences in the prevalence of dysrhythmia, chylothorax, acute respiratory distress syndrome, or recurrent laryngeal nerve injury between the two groups, which may be due to the limited sample size.

Conclusion

Considering the comparable survival rates, disease control, and fewer postoperative complications in the evaluated participants, SML is the preferred treatment with less invasiveness for clinical stage I NSCLC.

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Acknowledgements

Funding

This research was supported by the National Natural Science Foundation of China (81702242) for data collection. The journal’s Rapid Service fees were funded by the Authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship Contributions

Conceptualization: Siyuan Dong; Methodology: Ji Luo and Shize Yang; Wring: Ji Luo and Shize Yang.

Disclosures

Ji Luo, Shize Yang, and Siyuan Dong all confirm they have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Data Availability

All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Thoracic Surgery, The First Hospital of China Medical University, 155 North Nanjing St, Shenyang, 110001, Liaoning, China

    Ji Luo, Shize Yang & Siyuan Dong

Authors
  1. Ji Luo
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Corresponding author

Correspondence to Siyuan Dong.

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Luo, J., Yang, S. & Dong, S. Selective Mediastinal Lymphadenectomy or Complete Mediastinal Lymphadenectomy for Clinical Stage I Non-Small Cell Lung Cancer: A Meta-Analysis. Adv Ther 38, 5671–5683 (2021). https://doi.org/10.1007/s12325-021-01954-w

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  • DOI: https://doi.org/10.1007/s12325-021-01954-w

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