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. 2019 Apr;8(2):176-186.
doi: 10.21037/tlcr.2018.12.03.

A propensity score matching study of non-grasping en bloc mediastinal lymph node dissection versus traditional grasping mediastinal lymph node dissection for non-small cell lung cancer by video-assisted thoracic surgery

Chenglin Guo  1   2 , Liang Xia  1   2 , Jiandong Mei  1   2 , Chengwu Liu  1   2 , Feng Lin  1   2 , Lin Ma  1   2 , Qiang Pu  1   2 , Lunxu Liu  1   2
Affiliations

A propensity score matching study of non-grasping en bloc mediastinal lymph node dissection versus traditional grasping mediastinal lymph node dissection for non-small cell lung cancer by video-assisted thoracic surgery

Chenglin Guo et al. Transl Lung Cancer Res. 2019 Apr.

Abstract

Background: The aim of our study was to compare the efficacy of lymph node (LN) dissection, short-term surgical outcomes, and long-term outcomes between non-grasping en bloc mediastinal lymph node dissection (NE-MLND) and traditional grasping mediastinal lymph node dissection (G-MLND) under video-assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC).

Methods: We retrospectively analyzed 872 patients with pathological stage I-III NSCLC who underwent VATS. The patient's demographic characteristics, short-term surgical outcomes, overall survival (OS) and disease-free survival (DFS) were assessed. A propensity score-matched (PSM) analysis was performed between NE-MLND and G-MLND to reduce bias, and 349 pairs of patients were matched.

Results: Before propensity-score matching, for short-term surgical outcomes, the NE-MLND group had shorter operation time (P<0.001), more LNs removed (N1: P=0.002; N2: P<0.001; N1+N2: P<0.001), more pleural drainage during the first 3 days after surgery (P<0.001), and longer postoperative hospital stay (P<0.001). For long-term survival outcomes, the NE-MLND group had a longer OS (5-year OS: 71.8% vs. 64.8%, P=0.013), and there was no difference in DFS between the 2 groups (P=0.138). After propensity-score matching, the short-term surgical outcomes were consistent with the results before PSM. The OS and DFS in NE-MLND group were significantly longer than those in the G-MLND group (5-year OS: 76.4% vs. 63.5%, P=0.001 and 5-year DFS: 63.0% vs. 54.6%, P=0.033, respectively). Multivariate analysis showed that NE-MLND was an independent protective factor against OS [G-MLND: hazard ratio (HR) 1.461; 95% confidence interval (CI), 1.130-1.890; P=0.004].

Conclusions: NE-MLND is a safe, acceptable and superior approach to remove mediastinal LNs with shorter operation time. Patients with NSCLC may benefit from NE-MLND, which could lead to better OS and DFS as compared with G-MLND.

Keywords: Non-grasping; en bloc; mediastinal lymph node dissection (MLND); non-small cell lung cancer (NSCLC); video-assisted thoracic surgery (VATS).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart depicting the patient selection process. VATS, video-assisted thoracic surgery; MLN, mediastinal lymph node; LN, lymph node; NE-MLND, non-grasping en bloc mediastinal lymph node dissection; G-MLND, traditional grasping mediastinal lymph node dissection; CT, computed tomography.
Figure 2
Figure 2
Overall survival of patients between the non-grasping en bloc mediastinal lymph node dissection group and traditional grasping mediastinal lymph node dissection group. (A) Unmatched cohort (B) matched cohort. NE-MLND, non-grasping en bloc mediastinal lymph node dissection; G-MLND, traditional grasping mediastinal lymph node dissection.
Figure 3
Figure 3
Disease-free survival of patients between the non-grasping en bloc mediastinal lymph node dissection group and traditional grasping mediastinal lymph node dissection group. (A) Unmatched cohort (B) matched cohort. NE-MLND, non-grasping en bloc mediastinal lymph node dissection; G-MLND, traditional grasping mediastinal lymph node dissection.
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