Research advances in lymph node dissection in non-small cell lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Gang ¹ , LUO Jun ^2,3 , DENG Hanyu ^2,3,4 , ALAI Guha ^2,3 , ZHUO Zeguo ^2,3 ,  LIN Yidan ²

1. Depatment of Thoracic Surgery, Hospital of Chengdu Office of Tibet Autonomous Region People's Government, Chengdu, 610041, P.R.China;
2. West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
3. West China Clinical Medical College, Sichuan University, Chengdu, 610041, P.R.China;
4. Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

LIN Yidan, Email: linyidan.academy@foxmail.com

Keywords：

Non-small cell lung cancer; systematic lymph node dissection; sampling; leaf-specific lymph node dissection

DOI：

10.7507/1007-4848.201805016

Video：

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Abstract Full text Figures/Tables Video References Cited by

Lymph node metastasis in non-small cell lung cancer is an independent risk factor for poor prognosis. Resection of lymph nodes can improve the prognosis of patients. Although surgical techniques are progressing, there is still much controversy about the way of lymph node resection for non-small cell lung cancer. The research progress of hot topics such as the choice of lymph node resection methods for non-small cell lung cancer is discussed and summarized.

Citation： LI Gang, LUO Jun, DENG Hanyu, ALAI Guha, ZHUO Zeguo, LIN Yidan. Research advances in lymph node dissection in non-small cell lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(3): 282-289. doi: 10.7507/1007-4848.201805016 Copy

1.	Rami-Porta R, Asamura H, Travis WD, et al. Lung cancer - major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin, 2017, 67(2): 138-155.
2.	Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg, 2006, 30(5): 787-792.
3.	Hughes MJ, Chowdhry MF, Woolley SM, et al. In patients undergoing lung resection for non-small cell lung cancer, is lymph node dissection or sampling superior? Interact Cardiovasc Thorac Surg, 2011, 13(3): 311-315.
4.	Sugi K, Nawata K, Fujita N, et al. Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter. World J Surg, 1998, 22(3): 290-294.
5.	Okada M, Sakamoto T, Yuki T, et al. Selective mediastinal lymphadenectomy for clinico-surgical stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2006, 81(3): 1028-1032.
6.	Asamura H, Nakayama H, Kondo H, et al. Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis. J Thorac Cardiovasc Surg, 1999, 117(6): 1102-1111.
7.	Aokage K, Yoshida J, Ishii G, et al. Subcarinal lymph node in upper lobe non-small cell lung cancer patients: is selective lymph node dissection valid? Lung Cancer, 2010, 70(2): 163-167.
8.	Watanabe S, Asamura H, Suzuki K, et al. The new strategy of selective nodal dissection for lung cancer based on segment-specific patterns of nodal spread. Interact Cardiovasc Thorac Surg, 2005, 4(2): 106-109.
9.	Okada M, Tsubota N, Yoshimura M, et al. Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinomas: role of subcarinal nodes in selective dissection. J Thorac Cardiovasc Surg, 1998, 116(6): 949-953.
10.	Wu Y, Huang ZF, Wang SY, et al. A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer. Lung Cancer, 2002, 36(1): 1-6.
11.	Ma K, Chang D, He B, et al. Radical systematic mediastinal lymphadenectomy versus mediastinal lymph node sampling in patients with clinical stage ⅠA and pathological stage T1 non-small cell lung cancer. J Cancer Res Clin Oncol, 2008, 134(12): 1289-1295.
12.	Donington JS, Blasberg JD. Management of early stage non-small cell lung cancer in high-risk patients. Thorac Surg Clin, 2012, 22(1): 55-65.
13.	Ma K, Wang TY, He BL, et al. Impact of different mediastinal lymphadenectomy on clinical-stage ⅠA non-small cell lung cancer. Zhonghua Wai Ke Za Zhi, 2008, 46(9): 670-673.
14.	Adachi H, Sakamaki K, Nishii T, et al. Lobe-specific lymph node dissection as a standard procedure in surgery for non-small cell lung cancer: A propensity score matching study. J Thorac Oncol, 2017, 12(1): 85-93.
15.	Kaseda S, Hangai N, Yamamoto S, et al. Lobectomy with extended lymph node dissection by video-assisted thoracic surgery for lung cancer. Surg Endosc, 1997, 11(7): 703-706.
16.	Kaseda S, Aoki T, Hangai N. Video-assisted thoracic surgery (VATS) lobectomy: the Japanese experience. Semin Thorac Cardiovasc Surg, 1998, 10(4): 300-304.
17.	Wu N, Yan S, Lv C, et al. Does an extended mediastinal lymphadenectomy improve outcome after R0 resection in lung cancer? Chin J Cancer Res, 2014, 26(2): 183-191.
18.	Schirren J, Bölükbas S, Bergmann T, et al. Prospective study on perioperative risks and functional results in bronchial and bronchovascular sleeve resections. Thorac Cardiovasc Surg, 2009, 57(1): 35-41.
19.	Sakaguchi H, Ikeda S, Kawano R, et al. Surgical treatment of N2 involved non-small cell lung cancer——the systematic extended lymph node dissection based on the regional lymphatic drainage. Kyobu Geka, 1999, 52(11): 901-905.
20.	Hirata T, Koizumi K, Tanaka S. Changes in hemodynamics in patients who underwent extended mediastinal lymphadenectomy through median sternotomy for primary lung cancer. Jpn J Thorac Cardiovasc Surg, 2003, 51(5): 178-185.
21.	Watanabe S. Lymph node dissection for lung cancer: past, present, and future. Gen Thorac Cardiovasc Surg, 2014, 62(7): 407-414.
22.	Darling GE, Allen MS, Decker PA, et al. 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. J Thorac Cardiovasc Surg, 2011, 141(3): 662-670.
23.	Gajra A, Newman N, Gamble GP, et al. Effect of number of lymph nodes sampled on outcome in patients with stage Ⅰ non-small-cell lung cancer. J Clin Oncol, 2003, 21(6): 1029-1034.
24.	Yamanaka A, Hirai T, Fujimoto T, et al. Analyses of segmental lymph node metastases and intrapulmonary metastases of small lung cancer. Ann Thorac Surg, 2000, 70(5): 1624-1628.
25.	Matsumura Y, Hishida T, Yoshida J, et al. Reasonable extent of lymph node dissection in intentional segmentectomy for small-sized peripheral non-small-cell lung cancer: from the clinicopathological findings of patients who underwent lobectomy with systematic lymph node dissection. J Thorac Oncol, 2012, 7(11): 1691-1697.
26.	Cox ML, Yang CJ, Speicher PJ, et al. The role of extent of surgical resection and lymph node assessment for clinical stage Ⅰ pulmonary lepidic adenocarcinoma: An analysis of 1991 patients. J Thorac Oncol, 2017, 12(4): 689-696.
27.	Yoshioka M, Ichiguchi O. Selection of sublobar resection for c-stage ⅠA non-small cell lung cancer based on a combination of structural imaging by CT and functional imaging by FDG PET. Ann Thorac Cardiovasc Surg, 2009, 15(2): 82-88.
28.	Tsubokawa N, Tsutani Y, Miyata Y, et al. , Segmentectomy versus lobectomy for radiologically pure solid clinical T1a-bN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
29.	Nomori H. Segmentectomy for c-T1N0M0 non-small cell lung cancer. Surg Today, 2014, 44(5): 812-819.
30.	Zang RC, Qiu B, Gao SG, et al. A model predicting lymph node status for patients with clinical stage T1aN0-2M0 nonsmall cell lung cancer. Chin Med J (Engl), 2017, 130(4): 398-403.
31.	Lee SM, Park CM, Paeng JC, et al. Accuracy and predictive features of FDG-PET/CT and CT for diagnosis of lymph node metastasis of T1 non-small-cell lung cancer manifesting as a subsolid nodule. Eur Radiol, 2012, 22(7): 1556-1563.
32.	Wang L, Jiang W, Zhan C, et al. Lymph node metastasis in clinical stage ⅠA peripheral lung cancer. Lung Cancer, 2015, 90(1): 41-46.
33.	Wang T, Ma S, Yan T, et al. Clinical study of surgical treatment of non-small cell lung cancer  10 mm or less in diameter under video-assisted thoracoscopy. Zhongguo Fei Ai Za Zhi, 2016, 19(4): 216-219.
34.	Zhang GQ, Han F, Gao SL, et al. Two patterns of mediastinal lymph node resection for non-small cell lung cancer of stage ⅢA: survival analysis of 219 cases. Ai Zheng, 2007, 26(5): 519-523.
35.	Keller SM, Adak S, Wagner H, et al. Mediastinal lymph node dissection improves survival in patients with stages Ⅱ and Ⅲa non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg, 2000, 70(2): 358-365.
36.	Misthos P, Sepsas E, Kokotsakis J, et al. Prognosis of stage pⅢA non small cell lung cancer after mediastinal lymph node dissection or sampling. J BUON, 2009, 14(1): 45-49.
37.	Xiong J, Wang R, Sun Y, et al. Clinical analysis of sixty-four patients with T1aN2M0 stage non-small cell lung cancer who had undergone resection. Thorac Cancer, 2016, 7(2): 215-221.
38.	Farjah F, Lou F, Sima C, et al. A prediction model for pathologic N2 disease in lung cancer patients with a negative mediastinum by positron emission tomography. J Thorac Oncol, 2013, 8(9): 1170-1180.
39.	Chen K, Yang F, Jiang G, et al. Development and validation of a clinical prediction model for N2 lymph node metastasis in non-small cell lung cancer. Ann Thorac Surg, 2013, 96(5): 1761-1768.
40.	Zhang Y, Sun Y, Xiang J, et al. A prediction model for N2 disease in T1 non-small cell lung cancer. J Thorac Cardiovasc Surg, 2012, 144(6): 1360-1364.
41.	Koike T, Koike T, Yamato Y, et al. Predictive risk factors for mediastinal lymph node metastasis in clinical stage ⅠA non-small-cell lung cancer patients. J Thorac Oncol, 2012, 7(8): 1246-1251.
42.	Park HK, Jeon K, Koh WJ, et al. Occult nodal metastasis in patients with non-small cell lung cancer at clinical stage ⅠA by PET/CT. Respirology, 2010, 15(8): 1179-1184.
43.	Defranchi SA, Cassivi SD, Nichols FC, et al. N2 disease in T1 non-small cell lung cancer. Ann Thorac Surg, 2009, 88(3): 924-928.
44.	Huang X, Wang J, Chen Q, et al. Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis. PLoS One, 2014, 9(10): e109979.
45.	Su XD, Wang X, Rong TH, et al. Prognostic effect of mediastinal lymph node dissection in patients with stage Ⅰ non-small cell lung cancer. Zhonghua Wai Ke Za Zhi, 2007, 45(22): 1543-1545.
46.	Doddoli C, Aragon A, Barlesi F, et al. Does the extent of lymph node dissection influence outcome in patients with stage Ⅰ non-small-cell lung cancer? Eur J Cardiothorac Surg, 2005, 27(4): 680-685.
47.	Su X, Wang X, Long H, et al. Mediastinal lymph node dissection affects survival in patients with stage Ⅰ non-small cell lung cancer. Thorac Cardiovasc Surg, 2008, 56(4): 226-230.
48.	Jeon HW, Moon MH, Kim KS, et al. Extent of removal for mediastinal nodal stations for patients with clinical stage Ⅰ non-small cell lung cancer: effect on outcome. Thorac Cardiovasc Surg, 2014, 62(7): 599-604.
49.	Shen-Tu Y, Mao F, Pan Y, et al. Lymph node dissection and survival in patients with early stage nonsmall cell lung cancer: A 10-year cohort study. Medicine (Baltimore), 2017, 96(43): e8356.
50.	Darling GE, Allen MS, Decker PA, et al. Number of lymph nodes harvested from a mediastinal lymphadenectomy: results of the randomized, prospective American College of Surgeons Oncology Group Z0030 trial. Chest, 2011, 139(5): 1124-1129.
51.	Cerfolio RJ, Bryant AS, Minnich DJ. Complete thoracic mediastinal lymphadenectomy leads to a higher rate of pathologically proven N2 disease in patients with non-small cell lung cancer. Ann Thorac Surg, 2012, 94(3): 902-906.
52.	Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg, 2006, 81(3): 1013-1019.
53.	Bille A, Woo KM, Ahmad U, et al. Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage Ⅰ lung cancer patients. Eur J Cardiothorac Surg, 2017, 51(4): 674-679.
54.	Ishiguro F, Matsuo K, Fukui T, et al. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: a large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg, 2010, 139(4): 1001-1006.
55.	Hishida T, Miyaoka E, Yokoi K, et al. Lobe-specific nodal dissection for clinical stage Ⅰ and Ⅱ NSCLC: Japanese multi-institutional retrospective study using a propensity score analysis. J Thorac Oncol, 2016, 11(9): 1529-1537.
56.	Maniwa T, Okumura T, Isaka M, et al. Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2013, 44(1): e59-e64.
57.	Shapiro M, Kadakia S, Lim J, et al. Lobe-specific mediastinal nodal dissection is sufficient during lobectomy by video-assisted thoracic surgery or thoracotomy for early-stage lung cancer. Chest, 2013, 144(5): 1615-1621.
58.	Deng HY, Wang YC, Ni PZ, et al. Radiotherapy, lobectomy or sublobar resection A meta-analysis of the choices for treating stage Ⅰ non-small-cell lung cancer. Eur J Cardiothorac Surg, 2017, 51(2): 203-210.
59.	Fernandez FG, Crabtree TD, Liu J, et al. Sublobar resection versus definitive radiation in patients with stage ⅠA non-small cell lung cancer. Ann Thorac Surg, 2012, 94(2): 354-360.

1. Rami-Porta R, Asamura H, Travis WD, et al. Lung cancer - major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin, 2017, 67(2): 138-155.
2. Lardinois D, De Leyn P, Van Schil P, et al. ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer. Eur J Cardiothorac Surg, 2006, 30(5): 787-792.
3. Hughes MJ, Chowdhry MF, Woolley SM, et al. In patients undergoing lung resection for non-small cell lung cancer, is lymph node dissection or sampling superior? Interact Cardiovasc Thorac Surg, 2011, 13(3): 311-315.
4. Sugi K, Nawata K, Fujita N, et al. Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter. World J Surg, 1998, 22(3): 290-294.
5. Okada M, Sakamoto T, Yuki T, et al. Selective mediastinal lymphadenectomy for clinico-surgical stage Ⅰ non-small cell lung cancer. Ann Thorac Surg, 2006, 81(3): 1028-1032.
6. Asamura H, Nakayama H, Kondo H, et al. Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis. J Thorac Cardiovasc Surg, 1999, 117(6): 1102-1111.
7. Aokage K, Yoshida J, Ishii G, et al. Subcarinal lymph node in upper lobe non-small cell lung cancer patients: is selective lymph node dissection valid? Lung Cancer, 2010, 70(2): 163-167.
8. Watanabe S, Asamura H, Suzuki K, et al. The new strategy of selective nodal dissection for lung cancer based on segment-specific patterns of nodal spread. Interact Cardiovasc Thorac Surg, 2005, 4(2): 106-109.
9. Okada M, Tsubota N, Yoshimura M, et al. Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinomas: role of subcarinal nodes in selective dissection. J Thorac Cardiovasc Surg, 1998, 116(6): 949-953.
10. Wu Y, Huang ZF, Wang SY, et al. A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer. Lung Cancer, 2002, 36(1): 1-6.
11. Ma K, Chang D, He B, et al. Radical systematic mediastinal lymphadenectomy versus mediastinal lymph node sampling in patients with clinical stage ⅠA and pathological stage T1 non-small cell lung cancer. J Cancer Res Clin Oncol, 2008, 134(12): 1289-1295.
12. Donington JS, Blasberg JD. Management of early stage non-small cell lung cancer in high-risk patients. Thorac Surg Clin, 2012, 22(1): 55-65.
13. Ma K, Wang TY, He BL, et al. Impact of different mediastinal lymphadenectomy on clinical-stage ⅠA non-small cell lung cancer. Zhonghua Wai Ke Za Zhi, 2008, 46(9): 670-673.
14. Adachi H, Sakamaki K, Nishii T, et al. Lobe-specific lymph node dissection as a standard procedure in surgery for non-small cell lung cancer: A propensity score matching study. J Thorac Oncol, 2017, 12(1): 85-93.
15. Kaseda S, Hangai N, Yamamoto S, et al. Lobectomy with extended lymph node dissection by video-assisted thoracic surgery for lung cancer. Surg Endosc, 1997, 11(7): 703-706.
16. Kaseda S, Aoki T, Hangai N. Video-assisted thoracic surgery (VATS) lobectomy: the Japanese experience. Semin Thorac Cardiovasc Surg, 1998, 10(4): 300-304.
17. Wu N, Yan S, Lv C, et al. Does an extended mediastinal lymphadenectomy improve outcome after R0 resection in lung cancer? Chin J Cancer Res, 2014, 26(2): 183-191.
18. Schirren J, Bölükbas S, Bergmann T, et al. Prospective study on perioperative risks and functional results in bronchial and bronchovascular sleeve resections. Thorac Cardiovasc Surg, 2009, 57(1): 35-41.
19. Sakaguchi H, Ikeda S, Kawano R, et al. Surgical treatment of N2 involved non-small cell lung cancer——the systematic extended lymph node dissection based on the regional lymphatic drainage. Kyobu Geka, 1999, 52(11): 901-905.
20. Hirata T, Koizumi K, Tanaka S. Changes in hemodynamics in patients who underwent extended mediastinal lymphadenectomy through median sternotomy for primary lung cancer. Jpn J Thorac Cardiovasc Surg, 2003, 51(5): 178-185.
21. Watanabe S. Lymph node dissection for lung cancer: past, present, and future. Gen Thorac Cardiovasc Surg, 2014, 62(7): 407-414.
22. Darling GE, Allen MS, Decker PA, et al. 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. J Thorac Cardiovasc Surg, 2011, 141(3): 662-670.
23. Gajra A, Newman N, Gamble GP, et al. Effect of number of lymph nodes sampled on outcome in patients with stage Ⅰ non-small-cell lung cancer. J Clin Oncol, 2003, 21(6): 1029-1034.
24. Yamanaka A, Hirai T, Fujimoto T, et al. Analyses of segmental lymph node metastases and intrapulmonary metastases of small lung cancer. Ann Thorac Surg, 2000, 70(5): 1624-1628.
25. Matsumura Y, Hishida T, Yoshida J, et al. Reasonable extent of lymph node dissection in intentional segmentectomy for small-sized peripheral non-small-cell lung cancer: from the clinicopathological findings of patients who underwent lobectomy with systematic lymph node dissection. J Thorac Oncol, 2012, 7(11): 1691-1697.
26. Cox ML, Yang CJ, Speicher PJ, et al. The role of extent of surgical resection and lymph node assessment for clinical stage Ⅰ pulmonary lepidic adenocarcinoma: An analysis of 1991 patients. J Thorac Oncol, 2017, 12(4): 689-696.
27. Yoshioka M, Ichiguchi O. Selection of sublobar resection for c-stage ⅠA non-small cell lung cancer based on a combination of structural imaging by CT and functional imaging by FDG PET. Ann Thorac Cardiovasc Surg, 2009, 15(2): 82-88.
28. Tsubokawa N, Tsutani Y, Miyata Y, et al. , Segmentectomy versus lobectomy for radiologically pure solid clinical T1a-bN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
29. Nomori H. Segmentectomy for c-T1N0M0 non-small cell lung cancer. Surg Today, 2014, 44(5): 812-819.
30. Zang RC, Qiu B, Gao SG, et al. A model predicting lymph node status for patients with clinical stage T1aN0-2M0 nonsmall cell lung cancer. Chin Med J (Engl), 2017, 130(4): 398-403.
31. Lee SM, Park CM, Paeng JC, et al. Accuracy and predictive features of FDG-PET/CT and CT for diagnosis of lymph node metastasis of T1 non-small-cell lung cancer manifesting as a subsolid nodule. Eur Radiol, 2012, 22(7): 1556-1563.
32. Wang L, Jiang W, Zhan C, et al. Lymph node metastasis in clinical stage ⅠA peripheral lung cancer. Lung Cancer, 2015, 90(1): 41-46.
33. Wang T, Ma S, Yan T, et al. Clinical study of surgical treatment of non-small cell lung cancer  10 mm or less in diameter under video-assisted thoracoscopy. Zhongguo Fei Ai Za Zhi, 2016, 19(4): 216-219.
34. Zhang GQ, Han F, Gao SL, et al. Two patterns of mediastinal lymph node resection for non-small cell lung cancer of stage ⅢA: survival analysis of 219 cases. Ai Zheng, 2007, 26(5): 519-523.
35. Keller SM, Adak S, Wagner H, et al. Mediastinal lymph node dissection improves survival in patients with stages Ⅱ and Ⅲa non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg, 2000, 70(2): 358-365.
36. Misthos P, Sepsas E, Kokotsakis J, et al. Prognosis of stage pⅢA non small cell lung cancer after mediastinal lymph node dissection or sampling. J BUON, 2009, 14(1): 45-49.
37. Xiong J, Wang R, Sun Y, et al. Clinical analysis of sixty-four patients with T1aN2M0 stage non-small cell lung cancer who had undergone resection. Thorac Cancer, 2016, 7(2): 215-221.
38. Farjah F, Lou F, Sima C, et al. A prediction model for pathologic N2 disease in lung cancer patients with a negative mediastinum by positron emission tomography. J Thorac Oncol, 2013, 8(9): 1170-1180.
39. Chen K, Yang F, Jiang G, et al. Development and validation of a clinical prediction model for N2 lymph node metastasis in non-small cell lung cancer. Ann Thorac Surg, 2013, 96(5): 1761-1768.
40. Zhang Y, Sun Y, Xiang J, et al. A prediction model for N2 disease in T1 non-small cell lung cancer. J Thorac Cardiovasc Surg, 2012, 144(6): 1360-1364.
41. Koike T, Koike T, Yamato Y, et al. Predictive risk factors for mediastinal lymph node metastasis in clinical stage ⅠA non-small-cell lung cancer patients. J Thorac Oncol, 2012, 7(8): 1246-1251.
42. Park HK, Jeon K, Koh WJ, et al. Occult nodal metastasis in patients with non-small cell lung cancer at clinical stage ⅠA by PET/CT. Respirology, 2010, 15(8): 1179-1184.
43. Defranchi SA, Cassivi SD, Nichols FC, et al. N2 disease in T1 non-small cell lung cancer. Ann Thorac Surg, 2009, 88(3): 924-928.
44. Huang X, Wang J, Chen Q, et al. Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis. PLoS One, 2014, 9(10): e109979.
45. Su XD, Wang X, Rong TH, et al. Prognostic effect of mediastinal lymph node dissection in patients with stage Ⅰ non-small cell lung cancer. Zhonghua Wai Ke Za Zhi, 2007, 45(22): 1543-1545.
46. Doddoli C, Aragon A, Barlesi F, et al. Does the extent of lymph node dissection influence outcome in patients with stage Ⅰ non-small-cell lung cancer? Eur J Cardiothorac Surg, 2005, 27(4): 680-685.
47. Su X, Wang X, Long H, et al. Mediastinal lymph node dissection affects survival in patients with stage Ⅰ non-small cell lung cancer. Thorac Cardiovasc Surg, 2008, 56(4): 226-230.
48. Jeon HW, Moon MH, Kim KS, et al. Extent of removal for mediastinal nodal stations for patients with clinical stage Ⅰ non-small cell lung cancer: effect on outcome. Thorac Cardiovasc Surg, 2014, 62(7): 599-604.
49. Shen-Tu Y, Mao F, Pan Y, et al. Lymph node dissection and survival in patients with early stage nonsmall cell lung cancer: A 10-year cohort study. Medicine (Baltimore), 2017, 96(43): e8356.
50. Darling GE, Allen MS, Decker PA, et al. Number of lymph nodes harvested from a mediastinal lymphadenectomy: results of the randomized, prospective American College of Surgeons Oncology Group Z0030 trial. Chest, 2011, 139(5): 1124-1129.
51. Cerfolio RJ, Bryant AS, Minnich DJ. Complete thoracic mediastinal lymphadenectomy leads to a higher rate of pathologically proven N2 disease in patients with non-small cell lung cancer. Ann Thorac Surg, 2012, 94(3): 902-906.
52. Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg, 2006, 81(3): 1013-1019.
53. Bille A, Woo KM, Ahmad U, et al. Incidence of occult pN2 disease following resection and mediastinal lymph node dissection in clinical stage Ⅰ lung cancer patients. Eur J Cardiothorac Surg, 2017, 51(4): 674-679.
54. Ishiguro F, Matsuo K, Fukui T, et al. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: a large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg, 2010, 139(4): 1001-1006.
55. Hishida T, Miyaoka E, Yokoi K, et al. Lobe-specific nodal dissection for clinical stage Ⅰ and Ⅱ NSCLC: Japanese multi-institutional retrospective study using a propensity score analysis. J Thorac Oncol, 2016, 11(9): 1529-1537.
56. Maniwa T, Okumura T, Isaka M, et al. Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2013, 44(1): e59-e64.
57. Shapiro M, Kadakia S, Lim J, et al. Lobe-specific mediastinal nodal dissection is sufficient during lobectomy by video-assisted thoracic surgery or thoracotomy for early-stage lung cancer. Chest, 2013, 144(5): 1615-1621.
58. Deng HY, Wang YC, Ni PZ, et al. Radiotherapy, lobectomy or sublobar resection A meta-analysis of the choices for treating stage Ⅰ non-small-cell lung cancer. Eur J Cardiothorac Surg, 2017, 51(2): 203-210.
59. Fernandez FG, Crabtree TD, Liu J, et al. Sublobar resection versus definitive radiation in patients with stage ⅠA non-small cell lung cancer. Ann Thorac Surg, 2012, 94(2): 354-360.

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