Level 1: Likely reliable evidence

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 with systematic node sampling in patients with stage I-IIIA non-small cell lung cancer (NSCLC) having surgical resection (Cochrane Database Syst Rev. 2010;4:CD004699).

However, a recent randomized trial provides strong evidence that CMLND does not improve survival in patients with stage I or II disease (J Thorac Cardiovasc Surg. 2011;141:662-670). 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 five-year disease-free survival (68% vs. 69%). There were also no significant differences in local, regional, or distant recurrences. Median survival was 8.5 years vs. 8.1 years (not significant).

Alan Ehrlich, MD, is an assistant clinical professor in family medicine at the University of Massachusetts Medical School in Worcester.