Pattern of lung cancer recurrence after lung resection with bilateral lymph node dissection

Introduction. Several studies have shown the survival benefit of bilateral lymph node dissection as part of curative- -intent surgery for lung cancer. The pilot BML-1 study was the first randomized trial comparing bilateral with the standard (unilateral) systematic lymph node dissection. Material and methods. Patients with non-small cell lung cancer stage I–IIIA, who underwent anatomical lung resec­tion were randomised 1:1 to receive a bilateral or standard, unilateral lymphadenectomy. Data regarding the type of recurrence and time to recurrence were analysed. Results. The rate of locoregional recurrence in the bilateral lymphadenectomy and the standard lymphadenectomy were 2.7% and 5.3% and those of distant relapse were 24.3% and 23.7% respectively (p = 0.99). The follow-up time was 87 months. The mean time from surgery to recurrence was 35.0 months and 22.8 months, respectively (p = 0.83). Conclusions. There is no firm evidence that bilateral mediastinal lymphadenectomy (BML) is associated with a re­currence pattern that is different than that following the systematic lymph node dissection (SLND). We found a trend towards lower incidence of local recurrence and longer time to recurrence in the BML group, but the differences were statistically not significant. A large randomised study is warranted to further analyse this matter.