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Original Study| Volume 24, ISSUE 1, P51-59, January 2023

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The comparison of Lobe-Specific or Systematic Mediastinal Lymph Node Dissection for Early-Stage Lung Adenocarcinoma With Consolidation Tumor Ratio Over 0.5

  • Author Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Qihai Sui
    Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Author Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Huiqiang Yang
    Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
    Search for articles by this author
  • Author Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Jiacheng Yin
    Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Ming Li
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Xing Jin
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Zhencong Chen
    Correspondence
    Address for correspondence: Zhencong Chen, M.D. and Wei Jiang, M.D. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
    Search for articles by this author
  • Wei Jiang
    Correspondence
    Address for correspondence: Zhencong Chen, M.D. and Wei Jiang, M.D. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Qun Wang
    Affiliations
    Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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  • Author Footnotes
    # Q.S., H.Y. and J.Y. contributed equally to this work.
Published:August 14, 2022DOI:https://doi.org/10.1016/j.cllc.2022.08.005

      Abstract

      Introduction

      Surgery is the most effective treatment for early-stage lung cancer. This study will propose a personalized plan for mediastinal lymph node dissection in early-stage lung adenocarcinoma to reduce the risk of surgery and improve the quality of life.

      Methods

      This study retrospectively analyzed the patients underwent lobectomy and lymph node dissection in the Department of Thoracic Surgery, Zhongshan Hospital, Fudan University. Clinical stage I lung adenocarcinoma patients with solid component ratio (CTR) between 0.5 and 1 were included. Patients were divided into systematic (S-MLND) and lobe-specific (L-MLND) mediastinal lymph node dissection groups. The days of hospitalization, the presence or absence of complications, the recurrence-free survival rate, and the overall survival rate were calculated to evaluate the postoperative quality and operation risk of the patients.

      Results

      210 patients (138 L-MLND and 72 S-MLND) were included. 2 lymph node metastases appeared in the S-MLND group while none in the L-MLND group (P = .049). No differences were shown in age, tumor site, size, solid component, degree of tumor invasion, and stage. The proportion of patients with severe postoperative cough and the length of hospital stay in the L-MLND group decreased. The 5-year OS of the entire cohort was 98.1%, 98.6% in L-MLND, compared with 97.2% in S-MLND; RFS was 94.8%, 95.7% in L-MLND, compared with 93.0% in S-MLND.

      Conclusion

      For cIA lung adenocarcinoma, according to the Thin-slice CT within 1 month before the operation, if the main lesion was less than 3 cm and CTR over 0.5, L-MLND is as effective as S-MLND.

      Keywords

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