Systematic lymph node dissection in lung cancer surgery is widely accepted, but a study underscores risks like postoperative complications and immune system disruption from excessive nonmetastatic dissection, emphasizing the need for strategic advancements in optimal tactics.

The following is a summary of “A Shift in Paradigm: Selective Lymph Node Dissection for Minimizing Oversurgery in Early Stage Lung Cancer,” published in the January 2024 issue of Oncology by Jiang, et al.

Systematic lymph node dissection has developed into a common treatment for lung cancer surgery, and it has gained widespread acceptance within the medical community. Within the last several years, the idea of “minimal invasive surgery (MIS)” has brought about a significant shift in the surgical paradigm of lung cancer cancer treatment. Previous research has shown a lack of clarity about the therapeutic benefits of excessively dissecting lymph nodes that do not contain metastases. 

Meanwhile, it increases the risk of postoperative complications such as chylothorax and damage to the laryngeal nerve. Additionally, the dissection of lymph nodes that do not carry metastatic disease can disrupt the immune system, which may have a secondary impact on the underlying tumor or latent metastases. Both lobe-specific lymph node dissection and selective lymph node dissection are examples of creative methods that have been developed over the course of the last several decades.

In the study, researchers analyzed the detrimental consequences of excessive nonmetastatic lymph node dissection and described the current advancements in optimum dissection tactics. The goal was to present new insights into the future directions of lymph node dissection. The discussion was based on the development of a lymph node dissection strategy.

Source: sciencedirect.com/science/article/abs/pii/S1556086423022451