Tanase Bogdan Cosmin, Horvat Teodor, Davidescu Mihnea, Nistor Claudiu Eduard, Muntean Calin, Cozma Gabriel Veniamin, Nicola Alin, Bratosin Felix, Laitin Sorina Maria Denisa, Burlacu Alin
Department of Thoracic Surgery, Prof. Alexandru Trestioreanu Institute of Oncology, 022328 Bucharest, Romania.
Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Healthcare (Basel). 2025 Apr 21;13(8):957. doi: 10.3390/healthcare13080957.
The benefit of lobe-specific lymph node dissection (LS-LND) in non-small cell lung cancer (NSCLC) remains debated, especially in early-stage disease. Previous reviews often included all stages, leaving a gap in focused evaluations of clinical stage IA-IB NSCLC. This systematic review, supplemented by our institutional experience, aimed to compare overall survival (OS), recurrence-free survival (RFS), and postoperative complications between LS-LND and systematic lymph node dissection (S-LND) in clinical stage IA-IB NSCLC.
We retrospectively reviewed 24 patients treated at our institution (14 S-LND vs. 10 LS-LND). Data on patient demographics, operative details, OS, RFS, and postoperative complications were collected. Risk of bias was assessed using established methodological tools. A targeted literature search was conducted in PubMed, EMBASE, and Web of Science from inception to 14 April 2022. Only three articles (total = 1101 patients) met inclusion criteria focusing on clinical stage IA-IB NSCLC who underwent curative-intent resection.
LS-LND demonstrated comparable or slightly improved 5-year OS (range: 69.7-96.7%) versus S-LND (64.9-92.0%), and similar or slightly higher RFS (66.0-95.6% in LS-LND vs. 60.8-88.8% in S-LND). In our cohort, the 5-year OS was 78.6% in S-LND vs. 80.0% in LS-LND, and the 5-year RFS was 71.4% vs. 70.0%, respectively. Postoperative complications such as arrhythmias were less frequent in LS-LND groups overall. Our data showed a low rate of pneumonia in S-LND compared to LS-LND (7.1% vs. 10.0%); however, arrhythmias accounted for 14.3% in S-LND vs. 10.0% in LS-LND).
For clinical stage IA-IB NSCLC, LS-LND offers oncologic outcomes that are comparable to S-LND, with a potential for reduced postoperative complications. The findings from our institution align with these trends observed in the literature. While these results suggest potential advantages of lobe-specific approaches, definitive conclusions require further validation through larger, prospective randomized studies to confirm the clinical benefits of LS-LND in early-stage NSCLC.
肺叶特异性淋巴结清扫术（LS-LND）在非小细胞肺癌（NSCLC）中的益处仍存在争议，尤其是在早期疾病中。以往的综述通常涵盖了所有阶段，在对临床IA-IB期NSCLC的重点评估方面存在空白。本系统综述结合我们机构的经验，旨在比较临床IA-IB期NSCLC患者接受LS-LND和系统性淋巴结清扫术（S-LND）后的总生存期（OS）、无复发生存期（RFS）及术后并发症。
我们回顾性分析了在我们机构接受治疗的24例患者（14例接受S-LND，10例接受LS-LND）。收集了患者人口统计学、手术细节、OS、RFS及术后并发症的数据。使用既定的方法学工具评估偏倚风险。从数据库建库至2022年4月14日，在PubMed、EMBASE和Web of Science中进行了针对性文献检索。仅有3篇文章（共1101例患者）符合纳入标准，这些研究聚焦于接受根治性切除的临床IA-IB期NSCLC患者。
与S-LND相比，LS-LND的5年总生存率（范围：69.7%-96.7%）相当或略有提高（S-LND为64.9%-92.0%），无复发生存率相似或略高（LS-LND为66.0%-95.6%，S-LND为60.8%-88.8%）。在我们的队列中，S-LND的5年总生存率为78.6%，LS-LND为80.0%；5年无复发生存率分别为71.4%和70.0%。总体而言，LS-LND组术后心律失常等并发症的发生率较低。我们的数据显示，与LS-LND相比，S-LND组肺炎发生率较低（7.1%对10.0%）；然而，S-LND组心律失常发生率为14.3%，LS-LND组为10.0%。
对于临床IA-IB期NSCLC，LS-LND的肿瘤学结局与S-LND相当，且术后并发症可能减少。我们机构的研究结果与文献中观察到的这些趋势一致。虽然这些结果提示了肺叶特异性方法的潜在优势，但仍需要通过更大规模的前瞻性随机研究进一步验证，以证实LS-LND在早期NSCLC中的临床益处。
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