{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T03:55:11Z","timestamp":1761710111710,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,5]],"date-time":"2025-01-05T00:00:00Z","timestamp":1736035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background: Lymphadenectomy is considered a key part of the radical treatment of resectable lung cancer, although its appropriate extension in early stages is a debated topic due to the great heterogeneity of studies in the literature. This study aims to evaluate the impact of lymphadenectomy extent on survival and recurrence in the treatment of early-stage NSCLC patients undergoing lobectomy and lymph node dissection. Methods: Data from clinical stage I NSCLC patients undergoing lobectomy and hilar-mediastinal lymphadenectomy at two thoracic surgery centers from 2016 to 2019 were retrospectively evaluated. Information regarding perioperative outcomes and lymphadenectomy details was collected and analyzed, and their impact on OS, CSS, and DFS was assessed. Results: During the period under review, 323 patients with stage cI lung cancer underwent lobectomy with lymphadenectomy. Statistical analysis showed that the evaluated lymph nodal factors (mean number of lymph nodes removed and number and type of lymph node station explored) did not statistically significantly impact OS, CSS, and DFS at a median follow-up of 59 months (IQR 45\u201371). Conclusions: The results of this study suggest that a less invasive procedure than systematic lymphadenectomy could be performed in early-stage cases with adequate preoperative staging.<\/jats:p>","DOI":"10.3390\/curroncol32010031","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T08:08:52Z","timestamp":1736150932000},"page":"31","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Long-Term Oncological Outcomes Related to Lymphadenectomy in Clinical Stage I NSCLC: A Multicenter Retrospective Experience"],"prefix":"10.3390","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9932-5117","authenticated-orcid":false,"given":"Beatrice","family":"Manfredini","sequence":"first","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular and Critical Care Pathology Department, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3240-9313","authenticated-orcid":false,"given":"Carmelina Cristina","family":"Zirafa","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular and Critical Care Pathology Department, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Stefani","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano","family":"Romano","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular and Critical Care Pathology Department, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greta","family":"Al\u00ec","sequence":"additional","affiliation":[{"name":"Pathological Anatomy, Surgical, Medical, Molecular and Critical Care Pathology Department, University Hospital of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7783-0262","authenticated-orcid":false,"given":"Riccardo","family":"Morganti","sequence":"additional","affiliation":[{"name":"Section of Statistics, University Hospital of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2967-4153","authenticated-orcid":false,"given":"Ilaria","family":"Ceccarelli","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular and Critical Care Pathology Department, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federico","family":"Davini","sequence":"additional","affiliation":[{"name":"Minimally Invasive and Robotic Thoracic Surgery, Surgical, Medical, Molecular and Critical Care Pathology Department, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pier Luigi","family":"Filosso","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1773-8269","authenticated-orcid":false,"given":"Franca","family":"Melfi","sequence":"additional","affiliation":[{"name":"Unit of Thoracic Surgery, Department of Pharmacy and Health and Nutrition Sciences, University of Calabria, 87036 Rende, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"National Lung Screening Trial Research Team, Aberle, D.R., Adams, A.M., Berg, C.D., Black, W.C., Clapp, J.D., Fagerstrom, R.M., Gareen, I.F., Gatsonis, C., and Marcus, P.M. (2011). Reduced lung-cancer mortality with low-dose computed tomographic screening. N. Engl. J. Med., 365, 395\u2013409.","DOI":"10.1056\/NEJMoa1102873"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.thorsurg.2011.12.001","article-title":"The role of lymphadenectomy in lung cancer surgery","volume":"22","author":"Venuta","year":"2012","journal-title":"Thorac. Surg. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.ejcts.2006.08.008","article-title":"ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer","volume":"30","author":"Lardinois","year":"2006","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_4","unstructured":"(2024, September 10). Version 9.2024 \u00a9 2024 National Comprehensive Cancer Network\u00a9 (NCCN\u00a9). Non-Small Cell Lung Cancer. Available online: https:\/\/www.nccn.org\/professionals\/physician_gls\/pdf\/nscl.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"iv1","DOI":"10.1093\/annonc\/mdx222","article-title":"Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"28","author":"Postmus","year":"2017","journal-title":"Ann Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.lungcan.2005.01.001","article-title":"Complete resection in lung cancer surgery: Proposed definition","volume":"49","author":"Wittekind","year":"2005","journal-title":"Lung Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1093\/ejcts\/ezw439","article-title":"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","volume":"51","author":"Mokhles","year":"2017","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1093\/ejcts\/ezw083","article-title":"Lymphadenectomy for clinical early-stage non-small-cell lung cancer: A systematic review and meta-analysis","volume":"50","author":"Meng","year":"2016","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5671","DOI":"10.1007\/s12325-021-01954-w","article-title":"Selective Mediastinal Lymphadenectomy or Complete Mediastinal Lymphadenectomy for Clinical Stage I Non-Small Cell Lung Cancer: A Meta-Analysis","volume":"38","author":"Luo","year":"2021","journal-title":"Adv. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/S1010-7940(03)00567-0","article-title":"Long-term results of pathological stage I non-small cell lung cancer: Validation of using the number of totally removed lymph nodes as a staging control","volume":"24","author":"Wu","year":"2003","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/j.ejcts.2004.12.035","article-title":"Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer?","volume":"27","author":"Doddoli","year":"2005","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"37","DOI":"10.2152\/jmi.55.37","article-title":"Effect of mediastinal lymph nodes sampling in patients with clinical stage I non-small cell lung cancer","volume":"55","author":"Takizawa","year":"2008","journal-title":"J. Med. Investig."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1007\/s00432-008-0421-3","article-title":"Radical systematic mediastinal lymphadenectomy versus mediastinal lymph node sampling in patients with clinical stage IA and pathological stage T1 non-small cell lung cancer","volume":"134","author":"Ma","year":"2008","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1097\/00000658-199801000-00020","article-title":"Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: Results of a prospective randomized trial","volume":"227","author":"Izbicki","year":"1998","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1007\/s002689900384","article-title":"Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter","volume":"22","author":"Sugi","year":"1998","journal-title":"World J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zhao, D., Zhang, R., Yang, L., Huang, Z., Lin, Y., Wen, Y., Zhang, X., Wang, G., Guo, G., and Yu, X. (2021). The Independent Prognostic Effect of Lymph Node Dissection on Patients with Stage IA NSCLC with Different T Stages. Front. Surg., 8.","DOI":"10.3389\/fsurg.2021.798046"},{"key":"ref_17","first-page":"188","article-title":"Charlson Comorbidity Index: ICD-9 Update and ICD-10 Translation","volume":"12","author":"Glasheen","year":"2019","journal-title":"Am. Health Drug Benefits"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1634\/theoncologist.2017-0659","article-title":"The Eighth Edition of TNM Staging of Lung Cancer: Reference Chart and Diagrams","volume":"23","author":"Lababede","year":"2018","journal-title":"Oncologist"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: Five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1164\/arrd.1983.127.5.659","article-title":"Clinical staging of primary lung cancer. American Thoracic Society node mapping scheme","volume":"127","author":"Friedman","year":"1983","journal-title":"Am. Rev. Respir. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/1010-7940(90)90006-L","article-title":"Intraoperative assessment of nodal staging at thoracotomy for carcinoma of the bronchus","volume":"4","author":"Gaer","year":"1990","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_22","first-page":"19","article-title":"Rationale for extended lymphadenectomy for lung cancer","volume":"5","author":"Hata","year":"1990","journal-title":"Theor. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0169-5002(01)00445-7","article-title":"A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer","volume":"36","author":"Wu","year":"2002","journal-title":"Lung Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.jtcvs.2010.11.008","article-title":"Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: Results of the American College of Surgery Oncology Group Z0030 Trial","volume":"141","author":"Darling","year":"2011","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Huang, C.C., Tang, E.K., Shu, C.W., Chou, Y.P., Goan, Y.G., and Tseng, Y.C. (2023). Comparison of the Outcomes between Systematic Lymph Node Dissection and Lobe-Specific Lymph Node Dissection for Stage I Non-small Cell Lung Cancer. Diagnostics, 13.","DOI":"10.3390\/diagnostics13081399"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1007\/s00268-014-2804-8","article-title":"Systematic mediastinal lymphadenectomy or mediastinal lymph node sampling in patients with pathological stage I NSCLC: A meta-analysis","volume":"39","author":"Dong","year":"2015","journal-title":"World J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s00464-018-6288-8","article-title":"Nodal upstaging evaluation in NSCLC patients treated by robotic lobectomy","volume":"33","author":"Zirafa","year":"2019","journal-title":"Surg. Endosc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.jtho.2022.12.009","article-title":"The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Overview of Challenges and Opportunities in Revising the Nodal Classification of Lung Cancer","volume":"18","author":"Osarogiagbon","year":"2023","journal-title":"J. Thorac. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/JTO.0b013e318206dbcc","article-title":"Screening-detected lung cancers: Is systematic nodal dissection always essential?","volume":"6","author":"Veronesi","year":"2011","journal-title":"J. Thorac. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Sun, J., Wu, S., Jin, Z., Ren, S., Cho, W.C., Zhu, C., and Shen, J. (2022). Lymph node micrometastasis in non-small cell lung cancer. Biomed. Pharmacother., 149.","DOI":"10.1016\/j.biopha.2022.112817"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Tsai, T.M., Liu, C.Y., Lin, M.W., Hsu, H.H., and Chen, J.S. (2022). Factors Associated with Nodal Upstaging in Clinical T1a-bN0M0 Non-Small Cell Lung Cancers. Cancers, 14.","DOI":"10.3390\/cancers14051277"}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/32\/1\/31\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:23:04Z","timestamp":1759918984000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/32\/1\/31"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,5]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["curroncol32010031"],"URL":"https:\/\/doi.org\/10.3390\/curroncol32010031","relation":{},"ISSN":["1718-7729"],"issn-type":[{"type":"electronic","value":"1718-7729"}],"subject":[],"published":{"date-parts":[[2025,1,5]]}}}