Influencing Factors on the Quality of Lymph Node Dissection for Stage IA Non-Small Cell Lung Cancer: A Retrospective Nationwide Cohort Study

Simple Summary The excision of the lymph nodes, known as lymphadenectomy, is an essential part of surgical operation for lung cancer. This nationwide study was conducted to identify factors influencing the quality of lymphadenectomy. We included 4271 patients who underwent a minimally invasive surgical operation for early-stage lung cancer. Our findings indicate that the requirements for lymphadenectomy were satisfied in 27.9% of patients. Statistical analysis revealed that patients who underwent positron emission tomography–computed tomography before surgery, patients with larger tumors, and those operated on by experienced surgeons had a higher accuracy of lymphadenectomy. Additionally, the study revealed a declining trend in the quality of lymphadenectomy over time. Importantly, more extensive lymph node excision did not correlate with elevated complication rates or in-hospital mortality. In light of these findings, it is imperative to implement actions aimed at enhancing the quality of lymphadenectomy for lung cancer. Abstract Lymphadenectomy is an essential part of complete surgical operation for non-small cell lung cancer (NSCLC). This retrospective, multicenter cohort study aimed to identify factors that influence the lymphadenectomy quality. Data were obtained from the Polish Lung Cancer Study Group Database. The primary endpoint was lobe-specific mediastinal lymph node dissection (L-SMLND). The study included 4271 patients who underwent VATS lobectomy for stage IA NSCLC, operated between 2007 and 2022. L-SMLND was performed in 1190 patients (27.9%). The remaining 3081 patients (72.1%) did not meet the L-SMLND criteria. Multivariate logistic regression analysis showed that patients with PET-CT (OR 3.238, 95% CI: 2.315 to 4.529; p < 0.001), with larger tumors (pT1a vs. pT1b vs. pT1c) (OR 1.292; 95% CI: 1.009 to 1.653; p = 0.042), and those operated on by experienced surgeons (OR 1.959, 95% CI: 1.432 to 2.679; p < 0.001) had a higher probability of undergoing L-SMLND. The quality of lymphadenectomy decreased over time (OR 0.647, 95% CI: 0.474 to 0.884; p = 0.006). An analysis of propensity-matched groups showed that more extensive lymph node dissection was not related to in-hospital mortality, complication rates, and hospitalization duration. Actions are needed to improve the quality of lymphadenectomy for NSCLC.

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