The Effect Of Lymph Node Dissection On The Prognosis Of Stage Ⅰ Non-small Cell Lung Cancer:A Meta-analysis

Objective:For patients with resectable early non-small cell lung cancer(NSCLC),surgical methods and lymph node dissection are still controversial.Therefore,we compared systemic lymph node dissection(SLND)with non-systemic lymph node dissection(including lung lobe specific lymph node dissection,Lymph node sampling)for clinical efficacy and safety of patients with early NSCLC.Methods:A computerized system was used to search the published publications of PubMed,Cochrane Library,and OVID databases as of October 2018.Collect randomized controlled trials and retrospectives of patients with NSCLC in the systematic lymph node dissection group(SLND)and non-systemic lymph node dissection group research analysis.The searched literatures were independently screened and data extracted by two researchers according to set inclusion / exclusion criteria.The Revman5.3 software was used to conduct meta-analysis of the included research data and draw a forest map.Results:A total of 2303 articles were retrieved,and 11 articles were finally included,of which 2 were RCT studies and the remaining 9 were retrospective studies with a total of 4,100 patients.Meta analysis results showed that SLND extended overall survival(OS)and disease-free survival(DFS)compared with the non-systemic lymph node dissection group,but the differences were not statistically significant,with HR = 0.69(95% CI 0.86-1.08,P = 0.49)and HR = 0.91(95% CI 0.69-1.20,P = 0.51).There were no statistical differences in postoperative complications(including pneumonia,acute coronary syndrome,heart failure,respiratory failure,pleural effusion,and chylothorax)in the two groups,but the incidence of pneumonia was higher in the SLND group,and pleural effusion The incidence was basically the same in the two groups,and the incidence of other complications was lower in the SLND group.The local recurrence rate and lymph node metastasis rate were low in the SLND group,but the distant metastasis rate and overall recurrence rate were high,and the differences were not statistically significant.The SLND group had longer operation time and sacral canal time,more blood loss during operation,and more lymph nodes were removed during operation.Compared with the non-systemic lymph node removal group,the difference was statistically significant.Conclusion:For early NSCLC patients,there was no statistically significant difference in survival benefit between SLND and non-systemic lymph node dissection,and the overall recurrence and distant metastasis were slightly higher in the SLND group,but there were no statistics on the occurrence of recent postoperative complications The difference,and prolonged the operation time,sacral canal time,increased blood loss during the operation,may have a certain impact on the quality of life of patients after surgery.It may provide some guidance for clinicians to choose the surgical method for patients with early NSCLC,but further largescale prospective studies are needed to verify it.