Lymphadenectomy is an essential part of complete surgical operation for non-small cell lung cancer (NSCLC). This retrospective, multicenter cohort study aimed to identify factors that influence the lymphadenectomy quality. Data were obtained from the Polish Lung Cancer Study Group Database. The primary endpoint was lobe-specific mediastinal lymph node dissection (L-SMLND). The study included 4271 patients who underwent VATS lobectomy for stage IA NSCLC, operated between 2007 and 2022. L-SMLND was performed in 1190 patients (27.9%). The remaining 3081 patients (72.1%) did not meet the L-SMLND criteria. Multivariate logistic regression analysis showed that patients with PET-CT (OR 3.238, 95% CI: 2.315 to 4.529;p< 0.001), with larger tumors (pT1a vs. pT1b vs. pT1c) (OR 1.292; 95% CI: 1.009 to 1.653;p= 0.042), and those operated on by experienced surgeons (OR 1.959, 95% CI: 1.432 to 2.679;p< 0.001) had a higher probability of undergoing L-SMLND. The quality of lymphadenectomy decreased over time (OR 0.647, 95% CI: 0.474 to 0.884;p= 0.006). An analysis of propensity-matched groups showed that more extensive lymph node dissection was not related to in-hospital mortality, complication rates, and hospitalization duration. Actions are needed to improve the quality of lymphadenectomy for NSCLC.
淋巴结清扫术是非小细胞肺癌（NSCLC）完整外科手术的重要组成部分。本项回顾性多中心队列研究旨在探讨影响淋巴结清扫质量的相关因素。数据来源于波兰肺癌研究组数据库，主要研究终点为肺叶特异性纵隔淋巴结清扫（L-SMLND）。研究纳入2007年至2022年间接受电视辅助胸腔镜肺叶切除术的4271例IA期NSCLC患者，其中1190例（27.9%）实施了L-SMLND，其余3081例（72.1%）未达到L-SMLND标准。多因素逻辑回归分析显示，接受PET-CT检查（OR 3.238，95% CI：2.315-4.529；p<0.001）、肿瘤体积较大（pT1a vs. pT1b vs. pT1c）（OR 1.292；95% CI：1.009-1.653；p=0.042）以及由经验丰富外科医师实施手术（OR 1.959，95% CI：1.432-2.679；p<0.001）的患者接受L-SMLND的概率更高。淋巴结清扫质量随时间推移呈下降趋势（OR 0.647，95% CI：0.474-0.884；p=0.006）。倾向性匹配分析表明，更广泛的淋巴结清扫与院内死亡率、并发症发生率及住院时长无显著相关性。当前亟需采取措施提升NSCLC淋巴结清扫质量。
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