Original Article
Selective versus systematic lymph node dissection (other than sampling) for clinical N2-negative non-small cell lung cancer: a meta-analysis of observational studies
Abstract
Background: The proper extent of lymph node dissection is still controversial. Hence, we compared the clinical efficacy between two strategies of lymph node dissection [selective lymph node dissection (SLND) and systematic lymph node dissection (LND)] for clinical N2-negative non-small cell lung cancer (NSCLC) patients.
Methods: After searching five databases, six cohort studies were eligible for this meta-analysis and the primary endpoint was overall survival (OS). In order to provide a comprehensive perspective, we estimated some perioperative outcomes as well. Either fixed effect or random effects model were properly selected to evaluate the data according to the heterogeneity of included studies.
Results: A total of 7,333 patients with clinical N2-negative NSCLC patients were analyzed for OS. The pooled results demonstrated that LND did not improve survival in OS [hazard ratio (HR) =1.05, 95% confidence interval (CI): 0.82–1.34, P=0.69] compared with SLND. In accordance with OS, there is no significant difference in DFS between LND and SLND (HR =0.98, 95% CI: 0.78–1.23, P=0.87). Moreover, SLND could significantly reduce the operative time [mean difference (MD) =−21.45, 95% CI: −29.53 to −13.36, P<0.001] and blood loss (MD =−28.88, 95% CI: −44.38 to −13.39, P<0.001). Both postoperative morbidity and recurrence showed no significant between two groups.
Conclusions: SLND is an alternative to LND for clinical N2-negative NSCLC patients, which may even provide clinical benefits. However, more randomized controlled trials (RCTs) are expected to determine whether SLND is valid and practical to become a standard procedure of surgical treatment for early-stage NSCLC patients.
Methods: After searching five databases, six cohort studies were eligible for this meta-analysis and the primary endpoint was overall survival (OS). In order to provide a comprehensive perspective, we estimated some perioperative outcomes as well. Either fixed effect or random effects model were properly selected to evaluate the data according to the heterogeneity of included studies.
Results: A total of 7,333 patients with clinical N2-negative NSCLC patients were analyzed for OS. The pooled results demonstrated that LND did not improve survival in OS [hazard ratio (HR) =1.05, 95% confidence interval (CI): 0.82–1.34, P=0.69] compared with SLND. In accordance with OS, there is no significant difference in DFS between LND and SLND (HR =0.98, 95% CI: 0.78–1.23, P=0.87). Moreover, SLND could significantly reduce the operative time [mean difference (MD) =−21.45, 95% CI: −29.53 to −13.36, P<0.001] and blood loss (MD =−28.88, 95% CI: −44.38 to −13.39, P<0.001). Both postoperative morbidity and recurrence showed no significant between two groups.
Conclusions: SLND is an alternative to LND for clinical N2-negative NSCLC patients, which may even provide clinical benefits. However, more randomized controlled trials (RCTs) are expected to determine whether SLND is valid and practical to become a standard procedure of surgical treatment for early-stage NSCLC patients.
