title: Is radical mediastinal lymphadenectomy necessary for elderly patients with clinical N-negative non-small-cell lung cancer? A single center matched-pair study.
abstract: BACKGROUND
  The extent of lymph node dissection during surgery in elderly non-small-cell lung cancer patients remains controversial. We evaluated a cohort of elderly patients with clinical N0 disease who underwent lobectomy to determine if radical mediastinal lymphadenectomy (RML) is justified for the special group.
  
  
  METHODS
  A single-center database of patients over 70 y old from 2001-2011 was used to conduct a matched-pair analysis. The patients undergoing RML were matched 1:1 with those not (non-radical mediastinal lymphadenectomy group) by age, gender, American Society of Anesthesia score, histology, and clinical T status to assess their postoperative and long-term outcomes.
  
  
  RESULTS
  A total of 136 patients could be matched (68 RML and 68 non-radical mediastinal lymphadenectomy). No statistical difference was observed in postoperative mortality and overall morbidity rate between the matched groups (0 versus 1, P > 0.99 and 43 versus 35, P = 0.17). Patients undergoing RML experienced more major morbidities, but no significant difference was achieved (15 versus 7, P = 0.06). No significantly more N-positive diseases were discovered in RML group (N1 and N2 involvement disease: 16 versus 16, P > 0.99 and 10 versus 4, P = 0.09, respectively). RML was associated with a significantly longer cancer-related and disease-free survival (P = 0.02 and P = 0.02). Whereas for clinical IA diseases, significant differences were observed neither in cancer-related nor in disease-free survival (P = 0.67 and P = 0.61).
  
  
  CONCLUSIONS
  The performance of RML seemed to result in a tendency of higher major morbidity rate in elderly patients, but to contribute a favorable impact on long-term survival. However, for clinical IA patients the survival benefits were not obtained.
authors.affiliation: Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, PR China.
authors.forename: Yuzhao
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, PR China.
authors.forename: Nan
authors.initials: N
authors.lastname: Wu
authors.affiliation: Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, PR China.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, PR China.
authors.forename: Chao
authors.initials: C
authors.lastname: Lv
authors.affiliation: Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, PR China.
authors.forename: Shi
authors.initials: S
authors.lastname: Yan
authors.affiliation: Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, PR China.
authors.forename: Shaolei
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, PR China.
authors.forename: Yinan
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, PR China.
authors.forename: Lijian
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, PR China. Electronic address: zlyangyue@bjmu.edu.cn.
authors.forename: Yue
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008197:Lymph Node Excision / Q000706:statistics & numerical data*; D008297:Male; D016555:Matched-Pair Analysis; D008482:Mediastinum / Q000601:surgery*; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D019564:Unnecessary Procedures
keywords: Elderly; Morbidity; Non–small-cell lung cancer; Radical mediastinal lymphadenectomy; Survival