Omitting lymph node dissection for small ground glass opacity-dominant tumors

BACKGROUND The study purpose was to determine the optimal extent of lymph node dissection required in patients with small (≤ 3 cm) radiologically ground-glass opacity-dominant, peripheral, non-small cell lung cancer tumors. METHODS We analyzed the clinicopathological findings/surgical outcomes of 988 patients with radiological, ground glass opacity-dominant non-small cell lung cancer without lymph node involvement who underwent complete resection of the primary tumor between 2010 and 2020. Patients were followed for 54.5 months (median). Kaplan–Meier curves and log-rank test were used in statistical analyses of the prognosis. RESULTS Median age, whole tumor size, solid tumor size, and maximum standardized uptake value were 68 years, 1.7 cm, 0.4 cm, and 0.9, respectively. Sixty percent of the cohort were females (n = 590). Wedge resection, segmentectomy, and lobectomy were performed in 206, 372, and 410 patients, respectively. A total of 982 of 988 (99%) tumors were adenocarcinoma. One patient had hilar lymph node involvement; however, no mediastinal lymph node metastasis or hilar or mediastinal lymph node recurrence was detected. Five-year overall survival rate was 96.5% (95% confidence interval (CI): 94.8 – 97.7%). Excellent survival outcomes were achieved regardless of procedure (wedge resection, 94.7% [95% CI: 89.1 – 97.5%]; segmentectomy, 96.9% [95% CI: 93.7 – 98.5%]; lobectomy, 97.1% [95% CI: 94.4 – 98.5%]). CONCLUSIONS Omitting lymph node dissection may be acceptable with curative intent for small tumors with radiological ground glass opacity dominance. Appropriate surgical procedures such as wedge resection, segmentectomy, or lobectomy can provide satisfactory outcomes in patients with indolent tumors if surgical margins are secured.