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Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis.

ABSTRACT: OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the overall survival, local recurrence, distant metastasis, and complications of mediastinal lymph node dissection (MLND) versus mediastinal lymph node sampling (MLNS) in stage I-IIIA non-small cell lung cancer (NSCLC) patients. METHODS: A systematic search of published literature was conducted using the main databases (MEDLINE, PubMed, EMBASE, and Cochrane databases) to identify relevant randomized controlled trials that compared MLND vs. MLNS in NSCLC patients. Methodological quality of included randomized controlled trials was assessed according to the criteria from the Cochrane Handbook for Systematic Review of Interventions (Version 5.1.0). Meta-analysis was performed using The Cochrane Collaboration's Review Manager 5.3. The results of the meta-analysis were expressed as hazard ratio (HR) or risk ratio (RR), with their corresponding 95% confidence interval (CI). RESULTS: We included results reported from six randomized controlled trials, with a total of 1,791 patients included in the primary meta-analysis. Compared to MLNS in NSCLC patients, there was no statistically significant difference in MLND on overall survival (HR?=?0.77, 95% CI 0.55 to 1.08; P?=?0.13). In addition, the results indicated that local recurrence rate (RR?=?0.93, 95% CI 0.68 to 1.28; P?=?0.67), distant metastasis rate (RR?=?0.88, 95% CI 0.74 to 1.04; P?=?0.15), and total complications rate (RR?=?1.10, 95% CI 0.67 to 1.79; P?=?0.72) were similar, no significant difference found between the two groups. CONCLUSIONS: Results for overall survival, local recurrence rate, and distant metastasis rate were similar between MLND and MLNS in early stage NSCLC patients. There was no evidence that MLND increased complications compared with MLNS. Whether or not MLND is superior to MLNS for stage II-IIIA remains to be determined.

SUBMITTER: Huang X

PROVIDER: S-EPMC4190366 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis.

Huang Xiongfeng X Wang Jianmin J Chen Qiao Q Jiang Jielin J

PloS one 20141008 10

<h4>Objective</h4>This systematic review and meta-analysis aimed to evaluate the overall survival, local recurrence, distant metastasis, and complications of mediastinal lymph node dissection (MLND) versus mediastinal lymph node sampling (MLNS) in stage I-IIIA non-small cell lung cancer (NSCLC) patients.<h4>Methods</h4>A systematic search of published literature was conducted using the main databases (MEDLINE, PubMed, EMBASE, and Cochrane databases) to identify relevant randomized controlled tri ...[more]

PMID: 25296033

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Project description:BackgroundThe current preferred approach for surgical mediastinal staging of non-small-cell lung carcinoma is video-assisted mediastinoscopy. An alternative technique in which lymph nodes are resected instead of biopsied is video-assisted mediastinoscopic lymphadenectomy (VAMLA) that is suggested to be superior in detecting N2 disease. Yet, evidence is conflicting and furthermore limited by sample size. The objective was to compare mediastinal staging through VAMLA and video-assisted mediastinoscopy.MethodsA single-center cohort study was conducted. All consecutive patients that underwent surgical mediastinal staging of non-small-cell lung carcinoma by VAMLA (2011 to 2018) were compared to historic video-assisted mediastinoscopy controls (2007 to 2011). Patients with negative surgical mediastinal staging underwent subsequent anatomical resection with systematic regional lymphadenectomy. Primary outcome was the sensitivity and negative predictive value for detecting N2 disease.ResultsTwo-hundred-sixty-nine video-assisted mediastinoscopic lymphadenectomies and 118 video-assisted mediastinoscopies were performed. The prevalence of N2 disease was 20% and 26% respectively in the VAMLA and video-assisted mediastinoscopy group, while the rate of unforeseen pN2 resulting from lymph node dissection during anatomical resection was 4% and 11%, respectively. Invasive staging using VAMLA demonstrated superior sensitivity of 0.82 and a negative predictive value of 0.96 when compared to video-assisted mediastinoscopy (0.62 and 0.89, respectively), offering a 64% decrease in risk of unforeseen pN2 following anatomical resection. However, VAMLA is also associated with a 75% risk increase on complications (P=0.36).ConclusionsWe conclude that performing invasive mediastinal lymph node assessment for staging of non-small-cell lung carcinoma, VAMLA should be the preferred technique with superior sensitivity and negative predictive value in detecting N2 disease. Though, VAMLA is also associated with an increased risk of complications.

Project description:BACKGROUND:Thoracoscopic lobectomy combined with mediastinal lymph node dissection has been considered as one of the standard surgical procedures for early lung cancer. After 20 years of development, thoracoscopic lobectomy has reached a consensus on reliability and minimally invasive. At present, thoracoscopic lobectomy has a variety of incisions, which gradually evolve into four holes based on three holes, and two or one hole as the operative approach. The aim of this study was to evaluate the clinical value of four-hole unilateral dissecting lobectomy and mediastinal lymph node dissection in the treatment of non-small cell lung cancer (NSCLC). The aim of this study was to investigate the clinical value of anatomical lobectomy with mediastinal lymphadenectomy under four-hole completely video-assisted thoracoscopic surgery (C-VATS) in the treatment of non-small cell lung cancer. METHODS:The patients undergoing lobectomy with mediastinal lymphadenectomy for NSCLC were identified in the Department of Thoracic Surgery, Yangzhou First People's Hospital, Yangzhou University from March 2015 to July 2016. Preoperative clinical diagnosis of peripheral-type early NSCLC. The patients were randomly divided into four-hole monophasic group (experimental group) and three-hole group (control group) according to the number of hospitalization before surgery. According to inclusion and exclusion criteria, the 39 cases assign in experimental group and 34 cases in the control group, including 36 males and 37 females; aged 38 to 84 years. The mean operation time, average blood loss, lymph node dissection group, average drainage, average extubation time and postoperative complications were compared between the two groups for statistical analysis. RESULTS:The two groups of patients were successfully completed surgery, no death after surgery. Mean bleeding in the two groups, the number of lymph node dissection group, the average postoperative drainage, the average time of extubation, postoperative complications, with no significant difference. The average operation time of the four-hole unidirectional group was shorter than that of the three-hole group. The difference was statistically significant (P<0.05). CONCLUSIONS:The safety and efficacy of a four-hole one-way operation under VATS are satisfactory. The operation is smooth during operation, which shortens the course of operation and deserves the clinical promotion.?.

Dataset Information

Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis.

Publications

Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis.

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