Treatment for early stage non-small cell lung cancer is primarily surgical but the optimal extent of resection of mediastinal lymph nodes is unclear. A 2010 Cochrane review suggested that complete mediastinal lymph node dissection (CMLND) may increase overall survival compared to systematic node sampling in patients with stage I-IIIA non-small cell lung cancer (NSCLC) having surgical resection (Cochrane Database Syst Rev 2010 Apr 14;(4):CD004699). However, a recent randomized trial (ACOSOG Z0030) provides strong evidence that CMLND does not improve survival in patients with stage I or II disease. Patients with T1 or T2 and N0 or nonhilar N1 NSCLC had systematic mediastinal node sampling during resection. A total of 1,111 patients with negative findings during sampling were randomized intraoperatively to CMLND vs. no further sampling. After median follow-up of 6.5 years, there were no significant differences in death (41.5% vs. 43.5%) or 5-year disease-free survival (68% vs. 69%) (level 1 [likely reliable] evidence). There were also no significant differences in local, regional, or distant recurrences. Median survival was 8.5 years vs. 8.1 years (not significant) (J Thorac Cardiovasc Surg 2011 Mar;141(3):662).
For more information, see the Non-small cell lung cancer topic in DynaMed.