Prognostic Implications of Selective Dissection of Left Lower Paratracheal Lymph Nodes in Patients with Left-Sided Non-Small Cell Lung Cancer

• Published in: Journal of chest surgery Vol. 57; no. 5; pp. 467 - 476
• Main Authors: Park, Hyo Kyen, Kwon, Yelee, Lee, Geun Dong, Choi, Sehoon, Kim, Hyeong Ryul, Kim, Yong-Hee, Kim, Dong Kwan, Park, Seung-Il, Yun, Jae Kwang
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Society for Thoracic & Cardiovascular Surgery 05.09.2024; 대한심장혈관흉부외과학회
• Subjects: lung neoplasms; paratracheal lymph node; selective lymph node dissection; survival; 흉부외과학; Paratracheal lymph node; Selective lymph node dissection; Survival; Lung neoplasms
• ISSN: 2765-1606; 2765-1614
• DOI: 10.5090/jcs.24.022

This study aimed to examine the clinical implications of selective station 4L lymph node dissection (S4L-LND) on survival in non-small cell lung cancer (NSCLC) and to evaluate its potential advantages. We enrolled patients with primary left-sided NSCLC who underwent upfront video-assisted thoracoscopic surgery with R0 resection including lobectomy and segmentectomy, with or without S4L-LND, at our institution between January 2007 and December 2021. Following 1:1 propensity score matching (PSM), we compared overall survival (OS) and recurrence-free survival (RFS) between patients with and without S4L-LND. The study included 2,601 patients, of whom 1,126 underwent S4L-LND and 1,475 did not. PSM yielded 1,036 patient pairs. Among those who underwent S4L-LND, 87 (7.7%) exhibited S4L-LN involvement. Neither OS (p=0.12) nor RFS (p=0.24) differed significantly between matched patients with and without S4L-LND. In patients with S4L-LN involvement, metastases were more common in the left upper lobe (LUL) than in the left lower lobe (LLL) (3.6% vs. 2.0%, p=0.061). Metastasis became significantly more frequent with more advanced clinical N (cN) stage (cN0, 2.3%; cN1, 5.8%; cN2, 32.6%; p<0.001). Multivariate logistic regression analysis revealed that cN stage and tumor location were independently associated with S4L-LN involvement (p<0.001 for both). OS and RFS did not differ significantly between matched patients with and without S4L-LND. Among participants with S4L-LN involvement, metastases occurred more frequently in the LUL than the LLL, and their incidence increased significantly with more advanced cN stage. Thus, patients with LUL or advanced cN lung cancers may benefit from S4L-LND.