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Lobe‐Specific Versus Systematic Lymph Node Dissection in Clinical Stage I Non‐Small Cell Lung Cancer: A Propensity Score‐Matched Analysis Based on the 8th Edition of the TNM Stage Classification
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Lobe‐Specific Versus Systematic Lymph Node Dissection in Clinical Stage I Non‐Small Cell Lung Cancer: A Propensity Score‐Matched Analysis Based on the 8th Edition of the TNM Stage Classification
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Lobe‐Specific Versus Systematic Lymph Node Dissection in Clinical Stage I Non‐Small Cell Lung Cancer: A Propensity Score‐Matched Analysis Based on the 8th Edition of the TNM Stage Classification
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Journal Article
Lobe‐Specific Versus Systematic Lymph Node Dissection in Clinical Stage I Non‐Small Cell Lung Cancer: A Propensity Score‐Matched Analysis Based on the 8th Edition of the TNM Stage Classification
2026
Overview
Background The optimal extent of lymph node dissection (LND) in early‐stage non–small cell lung cancer (NSCLC) remains controversial. This study aimed to compare perioperative and oncological outcomes between lobe‐specific LND (LSD) and systematic LND (SND) in patients with clinical stage I NSCLC based on the 8th edition of the TNM classification. Methods We retrospectively analyzed 390 patients with clinical stage I NSCLC who underwent lobectomy with LND between 2010 and 2020. Patients with tumors in the right middle lobe or left lingular segment were excluded. Propensity score matching (PSM; 1:1 nearest‐neighbor matching) was performed using clinical and radiological covariates, yielding 140 matched patients in each group. Perioperative outcomes, postoperative complications (Clavien–Dindo grade ≥ II, with postoperative pneumonitis assessed according to CTCAE version 5.0), overall survival (OS), relapse‐free survival (RFS), and recurrence patterns were compared. Results After PSM, the LSD group had significantly shorter operative time, less blood loss, and shorter durations of chest tube placement and postoperative hospital stay than the SND group (all p < 0.05). Postoperative supraventricular tachyarrhythmia occurred more frequently in the SND group (0.7% vs. 7.1%, p = 0.006), whereas other complications were comparable. There were no significant differences in OS or RFS before or after PSM. Recurrence rates and patterns, including ipsilateral lymph node recurrence, were comparable. Conclusions LSD appears to be an oncologically valid and less invasive alternative to SND in patients with clinical stage I NSCLC. LSD may reduce surgical invasiveness and postoperative morbidity without compromising survival or increasing the risk of recurrence. In this propensity score‐matched study of clinical stage I non‐small cell lung cancer, lobe‐specific lymph node dissection achieved comparable overall and relapse‐free survival to systematic lymph node dissection while reducing operative invasiveness and postoperative supraventricular tachyarrhythmia.
Publisher
John Wiley & Sons Australia, Ltd,John Wiley & Sons, Inc,Wiley
