Clinical Benefits of Lobe-Specific Lymph Node Dissection in Surgery for NSCLC: A Systematic Review and Meta-Analysis
Introduction: The impact of lobe-specific lymph node dissection (LS-LND) in surgery for NSCLC remains controversial compared with that of systematic lymph node dissection (S-LND). This study aimed to compare clinical outcomes between the two strategies, including postoperative complications, and to...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-05-01
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| Series: | JTO Clinical and Research Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364323000553 |
| _version_ | 1797818674461016064 |
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| author | Wongi Woo, MD Jae Il Shin, MD, PhD Vincent Kipkorir, BSc Young Ho Yang, MD Sungsoo Lee, MD, PhD Chang Young Lee, MD, PhD |
| author_facet | Wongi Woo, MD Jae Il Shin, MD, PhD Vincent Kipkorir, BSc Young Ho Yang, MD Sungsoo Lee, MD, PhD Chang Young Lee, MD, PhD |
| author_sort | Wongi Woo, MD |
| collection | DOAJ |
| description | Introduction: The impact of lobe-specific lymph node dissection (LS-LND) in surgery for NSCLC remains controversial compared with that of systematic lymph node dissection (S-LND). This study aimed to compare clinical outcomes between the two strategies, including postoperative complications, and to explain the advantages of LS-LND. Methods: We searched for studies comparing LS-LND and S-LND up to April 14, 2022, using PubMed, EMBASE, and Web of Science. The primary outcomes were overall survival and recurrence-free survival. Secondary outcomes included postoperative complications, such as arrhythmia, chylothorax, and pneumonia. We evaluated the risk of bias and assessed the evidence quality using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Results: A total of 13 studies, including one randomized controlled trial and 12 retrospective studies with 11,522 patients who underwent curative resections for lung cancer, were included. The results indicated that LS-LND had favorable overall survival (hazard ratio [HR] = 0.80, 95% confidence interval [CI]: 0.73–0.87) but no difference in recurrence-free survival (HR = 0.96, 95% CI: 0.84–1.09) on comparison with S-LND. In terms of postoperative complications, patients undergoing LS-LND had a lower rate of chylothorax (risk ratio [RR] = 0.54, 95% CI: 0.35–0.85) and arrhythmia (RR = 0.74, 95% CI: 0.57–0.97) than patients undergoing S-LND, but the risk of postoperative pneumonia was not different. The overall quality of evidence was low to moderate owing to the risk of bias related to heterogeneous study populations. Conclusions: Patients undergoing LS-LND had a comparable and favorable long-term prognosis and a lower rate of postoperative complications. Nevertheless, further standardized studies are necessary to improve the quality of evidence. |
| first_indexed | 2024-03-13T09:11:28Z |
| format | Article |
| id | doaj.art-e61768f9095f403a81e8f11f33599819 |
| institution | Directory Open Access Journal |
| issn | 2666-3643 |
| language | English |
| last_indexed | 2024-03-13T09:11:28Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj.art-e61768f9095f403a81e8f11f335998192023-05-27T04:26:42ZengElsevierJTO Clinical and Research Reports2666-36432023-05-0145100516Clinical Benefits of Lobe-Specific Lymph Node Dissection in Surgery for NSCLC: A Systematic Review and Meta-AnalysisWongi Woo, MD0Jae Il Shin, MD, PhD1Vincent Kipkorir, BSc2Young Ho Yang, MD3Sungsoo Lee, MD, PhD4Chang Young Lee, MD, PhD5Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of KoreaDepartment of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of KoreaDepartment of Human Anatomy, School of Medicine, University of Nairobi, Nairobi, KenyaDepartment of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of KoreaDepartment of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of KoreaDepartment of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Corresponding author. Address for correspondence: Chang Young Lee, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea.Introduction: The impact of lobe-specific lymph node dissection (LS-LND) in surgery for NSCLC remains controversial compared with that of systematic lymph node dissection (S-LND). This study aimed to compare clinical outcomes between the two strategies, including postoperative complications, and to explain the advantages of LS-LND. Methods: We searched for studies comparing LS-LND and S-LND up to April 14, 2022, using PubMed, EMBASE, and Web of Science. The primary outcomes were overall survival and recurrence-free survival. Secondary outcomes included postoperative complications, such as arrhythmia, chylothorax, and pneumonia. We evaluated the risk of bias and assessed the evidence quality using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Results: A total of 13 studies, including one randomized controlled trial and 12 retrospective studies with 11,522 patients who underwent curative resections for lung cancer, were included. The results indicated that LS-LND had favorable overall survival (hazard ratio [HR] = 0.80, 95% confidence interval [CI]: 0.73–0.87) but no difference in recurrence-free survival (HR = 0.96, 95% CI: 0.84–1.09) on comparison with S-LND. In terms of postoperative complications, patients undergoing LS-LND had a lower rate of chylothorax (risk ratio [RR] = 0.54, 95% CI: 0.35–0.85) and arrhythmia (RR = 0.74, 95% CI: 0.57–0.97) than patients undergoing S-LND, but the risk of postoperative pneumonia was not different. The overall quality of evidence was low to moderate owing to the risk of bias related to heterogeneous study populations. Conclusions: Patients undergoing LS-LND had a comparable and favorable long-term prognosis and a lower rate of postoperative complications. Nevertheless, further standardized studies are necessary to improve the quality of evidence.http://www.sciencedirect.com/science/article/pii/S2666364323000553Lymph node dissectionLung cancerNon–small cell lung cancerSurgery |
| spellingShingle | Wongi Woo, MD Jae Il Shin, MD, PhD Vincent Kipkorir, BSc Young Ho Yang, MD Sungsoo Lee, MD, PhD Chang Young Lee, MD, PhD Clinical Benefits of Lobe-Specific Lymph Node Dissection in Surgery for NSCLC: A Systematic Review and Meta-Analysis JTO Clinical and Research Reports Lymph node dissection Lung cancer Non–small cell lung cancer Surgery |
| title | Clinical Benefits of Lobe-Specific Lymph Node Dissection in Surgery for NSCLC: A Systematic Review and Meta-Analysis |
| title_full | Clinical Benefits of Lobe-Specific Lymph Node Dissection in Surgery for NSCLC: A Systematic Review and Meta-Analysis |
| title_fullStr | Clinical Benefits of Lobe-Specific Lymph Node Dissection in Surgery for NSCLC: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Clinical Benefits of Lobe-Specific Lymph Node Dissection in Surgery for NSCLC: A Systematic Review and Meta-Analysis |
| title_short | Clinical Benefits of Lobe-Specific Lymph Node Dissection in Surgery for NSCLC: A Systematic Review and Meta-Analysis |
| title_sort | clinical benefits of lobe specific lymph node dissection in surgery for nsclc a systematic review and meta analysis |
| topic | Lymph node dissection Lung cancer Non–small cell lung cancer Surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2666364323000553 |
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