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Surgery for non-small cell lung cancer: systematic review and meta-analysis of randomised controlled trials
  1. G Wright1,
  2. R L Manser2,3,
  3. G Byrnes4,
  4. D Hart2,
  5. D A Campbell5
  1. 1Cardiothoracic Care Centre, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
  2. 2Department of Respiratory Medicine, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
  3. 3Clinical Epidemiology and Health Service Evaluation Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
  4. 4Centre for Genetic Epidemiology, The University of Melbourne, Parkville, Victoria, Australia
  5. 5Monash Institute of Health Services Research, Monash Medical Centre, Clayton, Victoria, Australia
  1. Correspondence to:
    Dr R L Manser
    Department of Respiratory Medicine,St Vincent’s Hospital Melbourne, Fitzroy, 3065,Victoria, Australia; manserrl{at}mh.org.au

Abstract

Background: Surgery is considered the treatment of choice for patients with resectable stage I and II (and some patients with stage IIIA) non-small cell lung cancer (NSCLC), but there have been no previously published systematic reviews.

Methods: A systematic review and meta-analysis of randomised controlled trials was conducted to determine whether surgical resection improves disease specific mortality in patients with stages I–IIIA NSCLC compared with non-surgical treatment, and to compare the efficacy of different surgical approaches.

Results: Eleven trials were included. No studies had untreated control groups. In a pooled analysis of three trials, 4 year survival was superior in patients undergoing resection with stage I–IIIA NSCLC who had complete mediastinal lymph node dissection compared with lymph node sampling (hazard ratio estimated at 0.78 (95% CI 0.65 to 0.93)). Another trial reported an increased rate of local recurrence in patients with stage I NSCLC treated with limited resection compared with lobectomy. One small study reported a survival advantage among patients with stage IIIA NSCLC treated with chemotherapy followed by surgery compared with chemotherapy followed by radiotherapy. No other trials reported significant improvements in survival after surgery compared with non-surgical treatment.

Conclusion: It is difficult to draw conclusions about the efficacy of surgery for locoregional NSCLC because of the small number of participants studied and methodological weaknesses of the trials. However, current evidence suggests that complete mediastinal lymph node dissection is associated with improved survival compared with node sampling in patients with stage I–IIIA NSCLC undergoing resection.

  • CMLND, complete mediastinal lymph node dissection
  • NSCLC, non-small cell lung cancer
  • RCT, randomised controlled trial
  • SS, systematic sampling
  • VATS, video assisted thorascopic surgery
  • lung cancer
  • surgery
  • meta-analysis

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Footnotes

  • Published Online First 31 January 2006

  • Dr Manser is supported by an Australian National Health and Medical Research Council postgraduate scholarship (scholarship number 201713).

  • Competing interests: none.