Systematic mediastinal lymph dissection (SMLD) as a standard of surgical treatment of patients with the I, II and IIIA stage nonsmall cell lung cancer (NSSLC)

Abstract

The reasonability of SMLD in lung carcinoma when compared with resection of enlarged lymph nodes only has been widely discussing in literature. This study was aimed to define the tumour extent and to improve results of surgical treatment of NSSLC applying the "extended" surgical interven tion (with SMLD) as a standard. The study analyzed short term and long term outcomes in 1109 NSSCL patients of 18 to 80 yrs old who were oper ated at the Russian Oncology Scientific Centre in 1980 to 1999. Of the total number of surgical interventions, 417 (37.6 %) were "extended" and 692 (62.4 %) were typical. In the "extended" surgery group, 86 (44.6 %) of the patients had NSSLC stage I, 144 (35.5 %) had the stage II and 87 (20.9 %) had the stage IIIA; in the "typical" group, there were 429 (62 %), 146 (21.1 %) and 117 (16.9 %) patients, respectively. The total survival was significantly higher in the SMLD group (p = 0.03). The 3 year survival and the 5 year survival was 65 % and 55 % after the extended surgery and 54 % and 43 % after the typical surgery, respectively.The tumour relapse in the bronchial stump in 6.2 %, metastases at the mediastinal lymph nodes in 8.7 % and at the supraclavicular lymph nodes in 1.7 % were found in the typical surgery group. These parameters in the extended surgery group were 1.9 %, 3.6 % and 0.9 %, respectively (p < 0.05). Thus, the SMLD technique improves long term results of surgical treatment of NSSLC stages I, II and IIIa. It decreases the rate of local relapses of the tumour and does not increase the rate of post surgery complications and mortality. This type of surgical intervention is thought to be the standard surgical treatment of lung carcinoma and has to be performed in all the patients despite of the tumour size, hystological, clinical and anatomical type and of its location in the lung.