SynthesisEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2017
Systematic lymphadenectomy versus sampling of ipsilateral mediastinal lymph-nodes during lobectomy for non-small-cell lung cancer: a systematic review of randomized trials and a meta-analysis.
Synthesis in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 49 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
49 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Division of the inferior pulmonary ligament during upper lobectomy does not improve postoperative pulmonary function: a systematic review and meta-analysis of observational studies and randomized controlled trials.World journal of surgical oncology · 2025Pooled it
- Survival After Mediastinal Node Dissection, Systematic Sampling, or Neither for Early Stage NSCLC.Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer · 2020Pooled it
- ASO Editorial: Lymph Node Dissection in the Immunotherapy Era: Friend or Foe?Annals of surgical oncology · 2026Article
- Prognostic Impact of Inadequate Lymph Node Evaluation in Early-Stage Lung Adenocarcinoma with Micropapillary or Solid Components.Annals of surgical oncology · 2026Article
- Local Control by Mediastinal Lymph-Node Dissection in Stage I Non-Small-Cell Lung Cancer.Interdisciplinary cardiovascular and thoracic surgery · 2026Article
- PreoperativeTranslational lung cancer research · 2026Article
- Construction and validation of a predictive model for benefits of tunnel-type mediastinal lymph node dissection in lung cancer patients based on the SEER database.BMC medical informatics and decision making · 2026Article
- Optimizing Lymph Node Staging in Non-Small Cell Lung Cancer Surgery: Evidence, Guidelines, and Quality Improvement Strategies.Journal of clinical medicine · 2026Review
- Mediastinal staging of nonsmall cell lung cancer: what's new?Breathe (Sheffield, England) · 2025Review
- Survival outcome after systematic lymphadenectomy in non-small cell lung cancer according to the latest proposed edition of the TNM system.Journal of thoracic disease · 2025Article
- Long-Term Oncological Outcomes Related to Lymphadenectomy in Clinical Stage I NSCLC: A Multicenter Retrospective Experience.Current oncology (Toronto, Ont.) · 2025Article
- Balancing oncological control and immune preservation in the immunotherapy era: revisiting lymph node dissection in non-small cell lung cancer.Frontiers in oncology · 2025Review
- Choice of wedge resection for selected T1a/bN0M0 non-small cell lung cancer.Scientific reports · 2024Article
- Metastatic pathways to the lower zone by segment in patients with clinical T1 lower lobe non-small cell lung cancer.General thoracic and cardiovascular surgery · 2024Article
- Impact of imaging features on selecting limited lymph node resection for cT1N0M0 lung cancer.Journal of thoracic disease · 2024Article
- Article
- A comparison of three-port and four-port Da Vinci robot-assisted thoracoscopic surgery for lung cancer: a retrospective study.Journal of cardiothoracic surgery · 2024Article
- Recent Advancements in Minimally Invasive Surgery for Early Stage Non-Small Cell Lung Cancer: A Narrative Review.Journal of clinical medicine · 2024Review
- Analysis of related factors and treatment effect of chylothorax after lung surgery.Journal of thoracic disease · 2024Article
- Article
Corrections and comments
- Commented on by
- Commented on byReply to Riquet.2017
- Commented on by
- Erratum issued
Authors and funding
8 authors.
Funding
Abstract
objectivesTo re-examine the evidence for recommendations for complete dissection versus sampling of ipsilateral mediastinal lymph nodes during lobectomy for cancer.
methodsWe searched for randomized trials of systematic mediastinal lymphadenectomy versus mediastinal sampling. We performed a textual analysis of the authors' own starting assumptions and conclusion. We analysed the trial designs and risk of bias. We extracted data on early mortality, perioperative complications, overall survival, local recurrence and distant recurrence for meta-analysis.
resultsWe found five randomized controlled trials recruiting 1980 patients spanning 1989-2007. The expressed starting position in 3/5 studies was a conviction that systematic dissection was effective. Long-term survival was better with lymphadenectomy compared with sampling (Hazard Ratio 0.78; 95% CI 0.69-0.89) as was perioperative survival (Odds Ratio 0.59; 95% CI 0.25-1.36, non-significant). But there was an overall high risk of bias and a lack of intention to treat analysis. There were higher rates (non-significant) of perioperative complications including bleeding, chylothorax and recurrent nerve palsy with lymphadenectomy.
conclusionsThe high risk of bias in these trials makes the overall conclusion insecure. The finding of clinically important surgically related morbidities but lower perioperative mortality with lymphadenectomy seems inconsistent. The multiple variables in patients, cancers and available treatments suggest that large pragmatic multicentre trials, testing currently available strategies, are the best way to find out which are more effective. The number of patients affected with lung cancer makes trials feasible.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.