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T. Smęder



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    OA 04 - Surgery from Minimal to Radical (ID 661)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Surgery
    • Presentations: 1
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      OA 04.01 - Randomised Trial of Systematic Lymph Node Dissection versus Bilateral Mediastinal Lymphadenectomy in Patients with Non-Small Cell Carcinoma (ID 7414)

      15:45 - 15:55  |  Author(s): T. Smęder

      • Abstract
      • Presentation
      • Slides

      Background:
      Experimental studies have shown different pathways of lymphatic drainage from particular pulmonary lobes. Especially important is lymphatic drainage from the left lower lobe to the contralateral mediastinal nodes. The aim of this study was to analyse the impact of bilateral mediastinal lymphadenectomy (BML) on survival in non small-cell lung cancer (NSCLC) patients.

      Method:
      Prospective, randomised trial including patients with proven or suspected NSCLC, stage cI-IIIA. Randomisation was performed in ratio 1:1. In the BML group, systematic lymph node dissection (SLND) was supplemented with contralateral mediastinal lymphadenectomy via additional cervical incision. In the SLND group, standard lung resection with SLND was performed.

      Result:
      102 patients were enrolled. 13 of them met the exclusion criteria, and data of 89 patients were analysed: 40 in the BML group and 49 in the SLND group. There were no significant differences between groups regarding age, sex, Thoracoscore, Revised Cardiac Risk Index, dyspnoea, lobar location of the tumour, histology and cTNM. Mean follow-up time was 66.5 months. In the whole group, the 4-year survival rate was significantly higher in the BML group than in the SLND group (72.5% vs 51%, p=0.039). Separate comparisons were performed for different lobar locations of the tumour. There was no significant difference in 4-year survival rates and mean survival time between both groups for tumours located in the right lung and those located in the left upper lobe. For the left lower lobe, the 4-year survival rate, and mean survival time was significantly higher in the BML group (90.9% vs 25%, p=0.003, and 1923 vs 1244 days, p=0.027, respectively). Also, analysis of the survival curves (Figure) has shown significant difference (p=0.018.).Figure 1



      Conclusion:
      For NSCLC located in the left lower lobe, removal of the contralateral mediastinal lymph nodes is associated with survival benefit. These results should be confirmed in larger studies.

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