Lobe-Specific Node Dissection Can Be a Suitable Alternative to Systematic Lymph Node Dissection in Highly Selective Early-Stage Non-Small-Cell Lung Cancer Patients: A Meta-Analysis

Purpose: Whether the lobe-specific lymph node dissection is an alternative to systematic lymph node dissection for early-stage non-small-cell lung cancer remains controversial. An elaborate meta-analysis was conducted to evaluate the effects of lobe-specific lymph node dissection in early-stage patients. Methods: A systematic literature search was conducted up to February 19, 2020 in PubMed, Ovid, Web of Science, and China National Knowledge Infrastructure databases. The outcomes including overall survival (OS), complications, and recurrence rate were extracted and analyzed. Results: Nine studies including one randomized controlled trial (RCT) and eight retrospective cohort studies with 8499 non-small-cell lung cancer patients were included. The results indicated that lobe-specific lymph node had a lower rate of postoperative complication (relative risk [RR]: 0.83, 95% confidence interval [CI]: 0.72–0.95, P = 0.006). No significant difference was observed between lobe-specific lymph node and systematic lymph node dissection in OS (hazard rate = 1.12, 95% CI: 0.81–1.54, P = 0.501) with high heterogeneity (I(2) = 71.9%). Conclusion: Lobe-specific lymph node can reach a comparable long-term prognosis in some highly selected patients. However, these results should be viewed cautiously with the existence of high heterogeneity. Due to the high heterogeneity, a strict patient selection process by experienced thoracic surgeons was recommended before validating lobe-specific lymph node.