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General Thoracic and Cardiovascular Surgery

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11.05.2022 | Original Article

Lobe-specific nodal dissection with intraoperative frozen section analysis for clinical stage-I non-small cell lung cancer: a validation study by propensity score matching

verfasst von: Mitsuhiro Isaka, Hideaki Kojima, Toru Imai, Hayato Konno, Tetsuya Mizuno, Toshiyuki Nagata, Shinya Katsumata, Takuya Kawata, Takashi Nakajima, Yasuhisa Ohde

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 11/2022

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Abstract

Objective

Lobe-specific nodal dissection (LND) is increasingly used for non-small cell lung cancer (NSCLC) in Japan; however, its treatment validity remains unclarified. Since 2013, LND has been used as a standard procedure for clinical stage-I (c-stage-I) NSCLC at our institution. We aimed to evaluate its validity using intraoperative frozen section analysis (FSA) for c-stage-I NSCLC.

Methods

The participants comprised patients with NSCLC who underwent LND between 2013 and 2016 (n = 307) or systematic nodal dissection (SND) between 2002 and 2013 (n = 367) for c-stage-I disease. FSA was routinely performed in LND to examine at least three stations. Outcomes were compared between the LND and SND groups. Patients in whom LND was converted to SND due to metastasis on FSA of the sampled lymph node were still categorized into the LND group, i.e., intention-to-treat analysis. The prognostic impact was compared using propensity score matching.

Results

The rate of conversion from LND to SND was 10.4%. Of the patients converted to SND, 12.5% had metastases outside the LND area. False-negative N2 results were detected in only 0.7% of the LND group patients after FSA. After matching, each group had 220 patients. There were no significant between-group differences in the lymph-node recurrence rate (7% vs. 6%), 5-year recurrence-free survival (80.1% vs. 79.0%), and overall survival (90.4% vs. 90.3%).

Conclusions

LND with intraoperative FSA is a valid modality that could serve as a standard surgical procedure for c-stage-I NSCLC. Intraoperative FSA may lower the residual lymph-node metastasis risk in LND.

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Titel: Lobe-specific nodal dissection with intraoperative frozen section analysis for clinical stage-I non-small cell lung cancer: a validation study by propensity score matching
verfasst von: Mitsuhiro Isaka
Hideaki Kojima
Toru Imai
Hayato Konno
Tetsuya Mizuno
Toshiyuki Nagata
Shinya Katsumata
Takuya Kawata
Takashi Nakajima
Yasuhisa Ohde
Publikationsdatum: 11.05.2022
Verlag: Springer Nature Singapore
Erschienen in: General Thoracic and Cardiovascular Surgery / Ausgabe 11/2022
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI: https://doi.org/10.1007/s11748-022-01827-1

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Lobe-specific nodal dissection with intraoperative frozen section analysis for clinical stage-I non-small cell lung cancer: a validation study by propensity score matching