Permissible Outcomes of Lobe-Specific Lymph Node Dissection for Elevated Carcinoembryonic Antigen in Non-Small Cell Lung Cancer

Abstract

Background and Objectives: Lobe-specific nodal dissection (L-SND) is currently acceptable for the dissection of early-stage non-small cell lung cancer (NSCLC) but not for cancers of more advanced clinical stages. We aimed to assess the efficacy of L-SND, compared to systemic nodal dissection (SND). Materials and Methods: We retrospectively collected the clinical data of patients with carcinoembryonic antigen (CEA) abnormality who underwent complete resection of NSCLC via lobectomy or more in addition to either SND or L-SND at two cancer-specific institutions from January 2006 to December 2017. Results: A total of 799 patients, including 265 patients who underwent SND and 534 patients who underwent L-SND, were included. On multivariate analysis, thoracotomy, more than lobectomy, cN1-2, advanced pathological stage, adjuvant treatment, and EGFR or ALK were strongly associated with SND. No significant differences were found in overall survival, disease-free survival, and overtime survival after propensity adjustment (p = 0.09, p = 0.11, and p = 0.50, respectively). There were no significant differences in local (p = 0.16), regional (p = 0.72), or distant (p = 0.39) tumor recurrence between the two groups. Conclusions: SND did not improve the prognosis of NSCLC patients with CEA abnormality. Complete pulmonary resection via L-SND seems useful for NSCLC patients with CEA abnormality.

Clinical Benefits of Lobe-Specific Lymph Node Dissection in Surgery for NSCLC: A Systematic Review and Meta-Analysis

“…Four studies had additional inclusion criteria, such as radiologic 16 , 23 , 24 or laboratory variables. 21 Most studies excluded patients who underwent neoadjuvant treatment and sublobar resection. Only five studies revealed explicitly precluded main lesions in the right middle lobe.…”

“…In terms of surgical procedures, the surgical extent has been modified because LS-LND was firstly suggested by Okada et al. 9 Though there was some variability in the lymph nodes that should be removed, six recent studies 10 , 16 , 21 , 23 , 24 , 25 had the same description, which represented an improved and well-established current practice ( Supplementary Table 3 ).…”

Risk factors for bronchopleural fistula after lobectomy for lung cancer

“…Satoh et al ( 22 ) reported that male, smoking, diabetes mellitus, subcarinal lymphadenectomy, and pulmonary complications were risk factors for postoperative ischemic bronchitis. Considering the risk of ischemic bronchitis and distribution of lymph node metastasis ( 15 , 16 , 23 ), lobe-specific selective lymphadenectomy has been our standard procedure for primary lung cancer, which could have possibly preserved blood flow at the bronchial stump, thereby reducing the incidence of BPF. In this study, history of gastric cancer surgery was significantly associated with the development of BPF.…”

“…The standard procedure for lung cancer in the study period was lobectomy with lobe-specific selective lymph node dissection ( 3 , 15 , 16 ), and subcarinal lymphadenectomy was omitted for lung cancer in right upper lobe and left upper division segment. In right lower lobe lung cancer, upper mediastinal lymph node dissection was omitted unless metastasis was found in the hilar and subcarinal lymph nodes.…”