According to an article recently published in the Annals of Thoracic Surgery, the complete removal of mediastinal (middle of the chest) lymph nodes does not increase complications or length of hospital stay among patients with early non-small cell lung cancer.
Lung cancer remains the leading cause of cancer-related deaths in the U.S. In fact, lung cancer is responsible for more deaths each year in this country than breast cancer, colon cancer, and prostate cancer combined.
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer; it in named for the type of cell within the lung where the cancer originates. Approximately 75-80% of individuals with lung cancer have NSCLC.
Early NSCLC refers to cancer that has not spread widely outside of its site of origin. The earlier lung cancer is detected and treated, the better the outcomes.
Standard treatment for early lung cancer consists of the surgical removal of as much of the cancer as possible followed by chemotherapy and/or radiation therapy.
Staging of cancer refers to how far and where the cancer has spread. Since treatment for lung cancer is determined by the stage and factors such as a patient’s overall health, accurately determining stage is a crucial part of optimal long-term outcomes.
The testing of nearby lymph nodes for the presence of cancerous cells is an important part of staging for lung cancer. There has been controversy about the extent of testing of lymph nodes.
Lymph node sampling and lymph node dissection are two approaches to lymph node removal. Lymph node sampling refers to testing a few lymph nodes in a region for the presence of cancerous cells. Lymph node dissection typically refers to the removal of many or all of the lymph nodes with in a region.
The controversy about these approaches involves weighing the potential improvements in outcomes of more extensive testing against the rate of complications, hospital stay, and impact on quality of life associated with more complete removal. On the other hand, some researchers believe that when more lymph nodes are removed for testing, nodes that may contain cancer and are responsible for cancer recurrences may be removed at this time; chance of recurrence is thus reduced. Certain researchers also believe that more extensive removal may improve the accuracy of staging. However, others believe that extensive removal of lymph nodes may increase complications and decrease quality of life with no long-term benefit.
Researchers from the Mayo Clinical recently conducted a study to compare mediastinal lymph node sampling (MLNS) to mediastinal lymph node dissection (MLND) among patients with early lung cancer. This study included 1,023 patients who underwent surgery to remove their cancer between 1999 and 2004. MLNS was performed in 498 patients and MLND was performed in 525 patients.
There was no increase in complications among patients undergoing MLND compared to those who underwent MLNS.
- Death associated with surgery occurred in 2% of patients who underwent MLNS compared to only 0.76% of patients who underwent MLND.
- Complications occurred in 38% of patients in both groups.
- There was no difference in the median duration of stay in the hospital following the procedure (six days in each group).
- Patients who underwent MLND were in surgery approximately 15 minutes longer than those who underwent MLNS.
The researchers concluded that MLND does not increase the risk of complications or hospital stay compared with MLNS during the staging of early NSCLC. The researchers note that longer follow-up is necessary to determine survival differences between these two groups of patients.
Patients with early-stage NSCLC may wish to speak with their physician regarding their individual risks and benefits of MLND.
Reference: Allen M, Darling G, Pechet T, et al. Morbidity and Mortality of Major Pulmonary Resections in Patients With Early-Stage Lung Cancer: Initial Results of the Randomized, Prospective ACOSOG Z0030 Trial. Annals of Thoracic Surgery. 2006; 81:1013-1020.