Is it really necessary to perform mediastinal lymphadenectomy in surgery for ground glass opacity-featured lung adenocarcinoma?

Abstract

: An increasing number of lung ground-glass opacity (GGO) are detected along with the popularity of low-dose computed tomography (LDCT) screening. Despite the excellent prognosis of GGO-featured lung cancers, systematic lymphadenectomy is still recommended for all resectable lesions. Much effort has been made to determine the conditions surrounding a limited resection for subsolid nodules. However, the necessity to perform systematic lymphadenectomy in radiologic GGO-featured lung adenocarcinomas (LUADs) remains controversial. Pure GGOs were reported had a 100% 5-year survival rate with no lymphatic metastasis, and the lymphatic metastasis rate in part-solid nodules (PSNs), especially in GGO-predominant PSNs, was significantly lower than that in pure solid nodules. The impact of lymphadenectomy on the prognosis and the specific predictors for lymphatic metastasis in PSNs are also discussed. Systematic lymphadenectomy was not yet proved to confer a survival benefit in patients with GGO-featured lung cancers. Integration of pre-/intra-operative information such as tumor size, consolidation tumor ratio (CTR) and pathological information is warrant for solid-predominant PSNs. Pre-invasive lesions rarely occurred lymph node metastasis and intraoperative frozen section (FS) results might provide pathological information before lymphadenectomy strategy determination. Finally, although randomized controlled trials are difficult to conduct in LUAD manifesting as GGO, more prospective studies are required to justify the indication of systematic lymphadenectomy.