493P - The prognostic value of 4L lymph node dissection in left-sided operable non-small cell lung cancer: A systematic review and meta-analysis

Background

Mediastinal lymph node dissection (MLND) is a crucial procedure during non-small cell lung cancer (NSCLC) resection, but the prognostic value of 4L lymph node dissection ( 4L-LND) continues to be controversial. Here, we conducted this systematic review and meta-analysis to evaluate the associations of 4L-LND with short- and long- term survival outcomes in surgically treated NSCLC patients.

Methods

We systematically searched studies from PubMed, Embase, and the Corchrane Library up to May 1, 2023. Studies investigating the prognostic value of 4L-LND and non-4L-LND on NSCLC survival were included. Data for analysis mainly included postoperative complications, overall survival (OS) and disease-free survival (DFS). We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of the included studies. The Q-test and I²-test were used to assess heterogeneity. The stability of pooled HRs was examined by sensitivity analysis.

Results

ix retrospective studies with a total of 4565 NSCLC patients who received 4L-LND or did not receive 4L-LND were included. The 4L-LND group had a significantly better OS (HR = 0.75, 95% CI: 0.61–0.91, P = 0.004) and DFS (HR = 0.76, 95% CI: 0.66–0.88, P = 0.0002) than the non-4L-LND group, especially in the subgroup analysis of PSM studies. Although no significant difference in chest tube drainage for more than 7 days rate (RR = 0.98, 95% CI: 0.31–3.08, P = 0.97), hoarseness rate (RR = 1.60, 95% CI: 0.53–4.87, P = 0.51), and chylothorax rate (RR = 1.28, 95% CI: 0.58–2.84, P = 0.54) was observed, however, those who received 4L-LND had a higher total postoperative complication rate than those who did not (RR = 1.35, 95% CI: 1.09–1.67, P = 0.006). There was no significant heterogeneity during our analysis, and no potential publication bias was observed among these studies.

Conclusions

Our meta-analysis showed that the 4L-LND group was significantly associated with both survival outcomes and postoperative complications compared to the non-4L-LND group in treating NSCLC patients. However, more prospective clinical trials should be well-designed to evaluate our conclusion due to the lack of guideline surpport.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

W. Li.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.