How does mediastinal lymphadenectomy affect survival outcomes in NSCLC?

Updated: Dec 10, 2019
  • Author: R James Koness, MD, FACS; Chief Editor: Erik D Schraga, MD  more...
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Answer

Four published randomized trials compared mediastinal lymph node dissection and mediastinal lymph node sampling. [9, 10, 11, 12]  A meta-analysis of the first three trials reported a survival advantage for stages I, II, and IIIA, and a fixed-effects model by the same group reported that mediastinal lymph node dissection reduced the risk of death. [13, 14]

In the multicenter, prospective, randomized ACOSOG Z0030 Trial, [12]  median survival was 8.1 years for mediastinal lymph node sampling and 8.5 years for mediastinal lymph node dissections. The authors concluded that mediastinal lymph node dissection does not improve survival in patients with early-stage NSCLC, but results are not generalizable to patients staged radiographically or those with higher-stage tumors. Formal en-bloc mediastinal resection may still affect survival and certainly optimally stages patients who do not undergo rigorous preoperative (mediastinoscopy) and intraoperative (mediastinal lymph node sampling) procedures.


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