Mediastinal lymph node dissection in older patients with non-small cell lung cancer

We evaluated the impact of omitting mediastinal lymph node dissection (MLND) from the surgical treatment of non-small cell lung cancer (NSCLC) in older patients. We collected data retrospectively on 2475 patients who underwent pulmonary resection for NSCLC at our hospital between June, 2006 and December 2018. The subjects of this analysis were 209 patients aged ≥ 75 years who underwent lobectomy for cN0–1 NSCLC. The patients were divided into two groups based on whether they underwent MLND (ND2 group) or not (group ND0–1). There were more patients aged ≥ 80 years in the ND0–1 group than in the ND2 group (p < 0.001). Patients in the ND0–1 group had clinically earlier stage lung cancers than those in the ND2 group (p = 0.053). We matched patient characteristics in the ND0–1 and ND2 groups by age, tumor diameter, cN, histology, and radiological findings. There were no significant differences in overall survival between the groups (p = 0.295). More patients in the ND2 group suffered complications (41.6% vs. 27.3%, p = 0.061) and arrhythmia episodes than those in the ND0–1 group (14.3% vs. 3.9%, p = 0.021). MLND in older patients may not extend survival but it could lead to complications. Thus, the omission of MLND may be considered for patients of advanced age.