Clin Surg | Volume 4, Issue 1 | Research Article | Open Access

Surgical Management of IIIA/N2 Non-Small Cell Lung Cancer; A Systematic Review

Amalie Lambert Kristensen1, Frank Vincenzo de Paoli1,2, Morten Bendixen1, Marianne Knap3, Azza Ahmed Khalil3 and Thomas Decker Christensen1*

1Department of Cardiothoracic, Vascular Surgery and Clinical Medicine, Aarhus University Hospital, Denmark
2Department of Biomedicine, Aarhus University, Denmark
3Department of Oncology and Clinical Medicine, Aarhus University Hospital, Denmark

*Correspondance to: Thomas Decker Christensen 

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Background: Non-Small Cell Lung Cancer (NSCLC) stage IIIA/N2 (cT1-3N2M0) represents a heterogenic group, and depending on the level of lymph node involvement, prognosis varies within this group. Optimal treatment is debated, and patients may have benefit from combined treatment modalities. The aim of this study was to assess the evidence regarding surgical treatment of stage IIIA/N2 NSCLC diagnosed before commencement of treatment.Methods: A systematic literature search for Randomized, Controlled Trials (RCT) comparing various combinations of treatments with surgery. Extraction of relevant data was performed, including study characteristics, patient characteristics, quality of trials and survival outcomes.Results: Five RCT’s with a total of 1166 patients were included. Treatment modalities varied substantially. None of the included studies found a statistically significant improved median overall survival, and only one study found an improved progression free survival when patients received chemotherapy, radiotherapy and surgery. Results, however indicates better locoregional control with surgery.Conclusion: Current clinical guidelines are not based on high-quality evidence. To assess the existing high-quality evidence on this subject, only RCT’s were included in this review. Results of statistical significance on survival are lacking, and studies show poor methodical quality. Based on the evidence available, surgery is not superior compared to other treatment modalities. Further subgroup analyses are needed, as evidence points toward surgery being beneficial for a subgroup of patients, possibly those with single-station N2 disease. RCT’s of high methodical quality are needed to determine optimal chemotherapy regimens, radiotherapy and concomitant surgical intervention.


Non-small cell lung cancer; Surgery; Chemotherapy; Radiotherapy


Kristensen AL, de Paoli FV, Bendixen M, Knap M, Khalil AA, Christensen TD. Surgical Management of IIIA/N2 Non-Small Cell Lung Cancer; A Systematic Review. Clin Surg. 2019; 4: 2327.

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