Reduced invasiveness of lobe-specific lymph node dissection in lung cancer surgery: Propensity score matching analysis using Japanese real-world data.

Abstract

In primary lung cancer surgery, whether lobe-specific lymph node dissection (LS-LND) reduces postoperative complications remains unclear, and the complications that may be reduced are uncertain. Thus, in this study, we aimed to evaluate the effect of LS-LND on reducing lymph node dissection (LND)-related complications. Data of 63,232 patients who underwent lobectomy with mediastinal LND for primary lung cancer between 2017 and 2019 were extracted from the Japanese National Clinical Database. We classified patients into two groups according to the mode of mediastinal LND and analyzed the differences in LND-related complication occurrences using propensity score matching (PSM). Overall, the LND-related complication rate was 6.4%, and pneumonia was the most prevalent complication (2.0%). Patients who underwent LS-LND tended to experience fewer LND-related complications than those who underwent systematic LND (S-LND) (5.8% vs. 7.9%). After PSM, LND-related complication rate was significantly lower in the LS-LND group than in the S-LND group (6.4% vs. 7.9%, p < 0.001) among 16,278 matched pairs. Chylothorax, pneumonia, and recurrent nerve paralysis showed marked intergroup differences in occurrence. Conversely, almost no intergroup difference was observed in the occurrence of bronchopleural fistula, empyema, and postoperative bleeding. In contrast, in the matched c-stage I subset, the incidence of cN0-pN2 upstaging was significantly lower in the LS-LND group than in the S-LND groups (5.3% vs. 9.0%). Our findings showed LS-LND is associated with fewer postoperative LND-related complications, and LS-LND may become a standard surgical procedure if randomized controlled trials demonstrate non-inferiority with regard to survival outcomes.