# Complete Mediastinal Lymph Node Dissection Does Not Increase Survival in Patients with Stage I or II NSCLC

 

 

      DynaMed Weekly Update - Volume 6, Issue 21 

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](http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004699/frame.html)). 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****](http://www.epnet.com/dynamed/levels.php)**). 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](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list%5Fuids=21335122&)).

For more information, see the [Non-small cell lung cancer](http://search.ebscohost.com/login.aspx?direct=true&site=dynamed&id=AN+114774) topic in DynaMed.