Selective mediastinal lymphadenectomy without intraoperative frozen section examinations for clinical stage I non-small-cell lung cancer: retrospective study of 403 cases.

OBJECTIVE: The extent of mediastinal lymphadenectomy for clinical stage I non-small-cell lung cancer (NSCLC) remains controversial. This study explored the value of selective mediastinal lymphadenectomy from the clinical viewpoint.

METHODS: From 2005 to 2008, a total of 403 patients diagnosed clinically as having stage I NSCLC underwent lobectomy and mediastinal lymph node dissection. Among them, 309 underwent complete mediastinal lymphadenectomy, and the other 94 underwent selective mediastinal lymphadenectomy. We compared the perioperative parameters and overall survival statistics for the two groups retrospectively.

RESULTS: The two groups had no significant differences in sex, pathology, tumor location, or preoperative staging. The selective mediastinal lymphadenectomy group had an older average age, with a much higher rate of patients >70 years of age (p = 0.016). Also, the patients were apt to undergo thoracoscopic lobectomy (p = 0.044). This group had shorter operating times and less intraoperative bleeding. No significant differences in total drainage volume, length of hospital stay, or complication rates were found between the two groups. The mean follow-up periods were 35.8 ± 13.7 vs. 34.6 ± 17.2 months. Local and distant recurrence rates were 25.6 % vs. 30.9 %, respectively (p = 0.560). The 3-year and 5-year overall survival rates were 83.0 % and 74.6 % vs. 75.1 % and 68.5 %, respectively (p = 0.216).

CONCLUSIONS: For patients with clinical stage I NSCLC, selective mediastinal lymphadenectomy can reduce the trauma caused by the procedure, especially for elderly patients and those with co-morbidities. Survival was acceptable and was no worse than that after complete mediastinal lymphadenectomy. Our results need to be confirmed by prospective randomized controlled studies.