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. 2025 Apr 21;13(8):957.
doi: 10.3390/healthcare13080957.

Curative-Intention Surgery with Lobe-Specific Versus Systematic Lymph Node Dissection in Clinical Stage IA-IB Non-Small Cell Lung Cancer: Our Experience and Literature Review

Bogdan Cosmin Tanase  1 , Teodor Horvat  1 , Mihnea Davidescu  1 , Claudiu Eduard Nistor  2 , Calin Muntean  3 , Gabriel Veniamin Cozma  4   5 , Alin Nicola  6   7 , Felix Bratosin  8 , Sorina Maria Denisa Laitin  8 , Alin Burlacu  1
Affiliations

Curative-Intention Surgery with Lobe-Specific Versus Systematic Lymph Node Dissection in Clinical Stage IA-IB Non-Small Cell Lung Cancer: Our Experience and Literature Review

Bogdan Cosmin Tanase et al. Healthcare (Basel). .

Abstract

Background and objectives: The benefit of lobe-specific lymph node dissection (LS-LND) in non-small cell lung cancer (NSCLC) remains debated, especially in early-stage disease. Previous reviews often included all stages, leaving a gap in focused evaluations of clinical stage IA-IB NSCLC. This systematic review, supplemented by our institutional experience, aimed to compare overall survival (OS), recurrence-free survival (RFS), and postoperative complications between LS-LND and systematic lymph node dissection (S-LND) in clinical stage IA-IB NSCLC.

Methods: We retrospectively reviewed 24 patients treated at our institution (14 S-LND vs. 10 LS-LND). Data on patient demographics, operative details, OS, RFS, and postoperative complications were collected. Risk of bias was assessed using established methodological tools. A targeted literature search was conducted in PubMed, EMBASE, and Web of Science from inception to 14 April 2022. Only three articles (total n = 1101 patients) met inclusion criteria focusing on clinical stage IA-IB NSCLC who underwent curative-intent resection.

Results: LS-LND demonstrated comparable or slightly improved 5-year OS (range: 69.7-96.7%) versus S-LND (64.9-92.0%), and similar or slightly higher RFS (66.0-95.6% in LS-LND vs. 60.8-88.8% in S-LND). In our cohort, the 5-year OS was 78.6% in S-LND vs. 80.0% in LS-LND, and the 5-year RFS was 71.4% vs. 70.0%, respectively. Postoperative complications such as arrhythmias were less frequent in LS-LND groups overall. Our data showed a low rate of pneumonia in S-LND compared to LS-LND (7.1% vs. 10.0%); however, arrhythmias accounted for 14.3% in S-LND vs. 10.0% in LS-LND).

Conclusions: For clinical stage IA-IB NSCLC, LS-LND offers oncologic outcomes that are comparable to S-LND, with a potential for reduced postoperative complications. The findings from our institution align with these trends observed in the literature. While these results suggest potential advantages of lobe-specific approaches, definitive conclusions require further validation through larger, prospective randomized studies to confirm the clinical benefits of LS-LND in early-stage NSCLC.

Keywords: lung cancer; mediastinal lymph nodes; oncology; thoracic surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Five-Year Overall Survival (OS). Hattori et al. (2021) [21], Zhao et al. (2021) [22], Ma et al. (2013) [23].
Figure 3
Figure 3
Five-Year Recurrence-Free Survival (RFS). Hattori et al. (2021) [21], Zhao et al. (2021) [22], Ma et al. (2013) [23].
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