Balancing precision and quality of life: Comparing systematic lymph node dissection and sampling in early-stage NSCLC through patient-reported outcomes

Abstract

Background

The increased detection of early-stage non-small cell lung cancer (NSCLC) has led to a discussion of optimal lymph node management modalities, particularly between systematic lymph node dissection (SLND) and lymph node sampling (LNS). The aim of this study was to compare early postoperative patient-reported outcomes (PROs) and short-term clinical outcomes of SLND and LNS.

Methods

A total of 394 patients with early-stage NSCLC were enrolled between December 2021 and December 2023. Patients were divided into SLND (n = 266) and LNS (n = 128) groups. Early postoperative symptoms, functional burdens and short-term clinical outcomes were compared between the two groups. Statistical analyses were performed using mixed-effects models and Kaplan-Meier analysis.

Results

Patients in the SLND group voluntarily reported more severe coughing in the early postoperative period (P = 0.046). The proportion of patients with moderate-to-severe coughing was significantly higher in the SLND group in the postoperative period of 1–4 days (P < 0.001). At 1–4 weeks post-discharge, the SLND group had a higher proportion of patients with moderate-to-severe pain (p = 0.009), shortness of breath (p = 0.001), disturbed sleep (p = 0.018), fatigue (p = 0.004) and distress (p = 0.002). In terms of short-term clinical outcomes, the operative times (P < 0.001), postoperative drainage time (P < 0.001), and postoperative hospital stays (P < 0.001) were significantly longer in the SLND group than in the LNS group.

Conclusion

SLND is associated with more severe symptoms, functional burden, and short-term clinical outcomes than LNS. LNS may be a more suitable surgical approach for early-stage NSCLC patients deemed lymph node-negative, optimizing both cancer management and postoperative quality of life.