Is systemic node dissection for accuracy staging in clinical stage I non-small cell lung cancer worthwhile in the elderly?
OBJECTIVE
The therapeutic role of systematic node dissection (SND) for early lung cancer remains controversial. Elderly patients have a background of insufficient physiological function and comorbidity, and a shorter life expectancy than that of younger patients. Therefore, we have evaluated the impact on survival, local recurrence, and complications of not performing systematic lymph node dissection in the elderly.


METHODS
A retrospective analysis of 126 patients, including the elderly (75 - 89 years), who underwent a lobectomy for clinical stage I was performed. The patients were grouped according to node dissection numbers after surgery, and finally separated into two groups (SG: sufficient group, dissections of more than 10 nodes and 3 or more mediastinal stations; IG: insufficient group, less than 10 nodes and one or two mediastinal stations). Postoperative morbidity and sites of recurrence were evaluated between the two groups, and the survival rates were analyzed at 5 years.


RESULTS
Upstage was identified in 12.6% of patients: 7.3% in IG (n = 45), 15.2% in SG (n = 86). Postoperative mortality occurred in 2 cases (1.58%). The incidence of postoperative respiratory or cardiac complications was more frequent in the SG, while there were fewer complications in the IG. There was no significant difference in recurrence rates between the two groups. Both local and distant recurrence was observed in the two groups. The 5-year survival rates were 61.5% for the SG and 59.4% for the IG. There was no significant difference in the survival rate between the IG and SG patients.


CONCLUSIONS
Proper staging and the avoidance of nontherapeutic lymph node dissection seems acceptable for clinical stage I lung cancer in the group of elderly patients.
Iwasaki
A
A
Department of Thoracic Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan. akinori@fukuoka-u.ac.jp
Hamatake
D
D
Hamanaka
W
W
Hamada
T
T
Shirakusa
T
T
Yamamoto
S
S
Shiraishi
T
T
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008197:Lymph Node Excision / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016019:Survival Analysis