ThoracicIs radical mediastinal lymphadenectomy necessary for elderly patients with clinical N-negative non-small-cell lung cancer? A single center matched-pair study

BackgroundThe 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.Patients and methodsA 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.ResultsA 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).ConclusionsThe 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.