Plain English Summary
Background and study aims
Lung cancer is the number 1 killer among all malignancies in both sexes. The most effective way to treat it is complete surgical resection (removal of part of the lung), which is possible in less advanced cases. Together with the diseased part of the lung, also lymph nodes are removed, as they often are cancer deposits. The standard systematic lymph node dissection (SLND) removes nodes but this only removes nodes from one side of the chest. Unfortunately, cancer deposits can develop also in the contralateral (opposite) side of the chest. This study is aimed at assessment of bilateral removal of the lymph nodes during lung cancer surgery.
Who can participate?
Adults aged 18 with non-small cell lung cancer.
What does the study involve?
Participants are randomly allocated to one of two groups. Those in the first group have their lung resection done with the standard procedure. Those in the second group receive the standard procedure as well as an additional lymph node dissection in the other side of their chest through a neck incision. Participants are followed for operative time, blood loss, number of lymph nodes removed and any other complication during the surgery. Participants are followed up after the surgery for their pain and survival.
What are the possible benefits and risks of participating?
The potential benefit is more complete resection achieved with bilateral removal of lymph nodes, resulting in better chance for cure. There is a possible increased risk of adverse effects as the procedure is more invasive.
Where is the study run from?
This study is being run by Jagiellonian University and takes place in hospitals in Poland, China, Germany, Austria, and Turkey.
When is the study starting and how long is it expected to run for?
January 2017 to December 2019
Who is funding the study?
1. Jagiellonian University in Krakow (Poland)
2. Sun Yat-sen University Cancer Center (China)
3. Catholic Hospital Koblenz (Germany)
4. Otto Wagner Hospital, Vienna (Austria)
5. ELK Berlin Chest Hospital, Berlin (Germany)
6. Istanbul University, Cerrahpasa Medical Faculty (Turkey)
7. Thoraxzentrum Ruhrgebiet (Germany)
8. University of Giessen (Germany)
Who is the main contact?
Professor Jaroslaw Kuzdzal
Trial website
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
1072.6120.91.2017
Study information
Scientific title
Comparison of unilateral and Bilateral Mediastinal Lymph node dissection in patients with non-small cell lung cancer
Acronym
BML-2
Study hypothesis
In patients operated on for non-small cell lung cancer, bilateral mediastinal lymph node dissection is associated with improved survival as compared with standard systematic lymph node dissection.
Ethics approval
Bio-ethical Committee of the Jagiellonian University, 30/06/2017, ref: decision No 1072.6120.91.2017
Study design
Prospective multicentre study
Primary study design
Interventional
Secondary study design
Randomised parallel trial
Trial setting
Hospitals
Trial type
Treatment
Patient information sheet
See additional files
Condition
Non-small cell lung cancer
Intervention
Prospective multicentre study with 1:1 randomisation using computer-generated random numbers. The intervention group includes patients undergoes bilateral mediastinal lymph node dissection (BML), and the control group includes participants who undergo standard systematic lymph node dissection (SLND).
Randomisation in the ratio 1:1 using computer-based random digit generator. All participants receive anatomical lung resection with SLND is performed according to the ESTS guidelines. VATS and thoracotomy approaches are acceptable. In the BML group, additional contralateral lymph node dissection is performed during the same anaesthesia, via separate neck incision (using either the VAMLA technique,10 or modified TEMLA technique15).
The following intraoperative parameters are recorded: operative time, blood loss, number of lymph nodes removed from each nodal station, any complications.
The following postoperative parameters are recorded: volume of chest tube output, time of chest drainage, time of air leak, pain intensity measured using the visual analogue scale (VAS), any complications, tumour relapse and survival recorded at least every three months in the first three years, and at least every six months in the 4th and 5th year after surgery.
Patients with stage pII or pIII (according to the final pathological report) are referred for adjuvant platinum-based chemotherapy.
Intervention type
Procedure/Surgery
Phase
Drug names
Primary outcome measure
1. Overall and cancer-specific 5-year survival rate is measured using the CRF data at 5-year survival is by definition measured 5 years after initiation of the treatment
2. DFS is measured using the CRF data at the time of closing the study 5 year after treatment of the last patient included
Secondary outcome measures
1. Operative time is measured using case report forms at the end of the procedure
2. Blood loss is measured using the scale of the suction device container at the end of the procedure
3. Pain intensity measured using VAS every 4 hours at the days 0, 1, 2, 3, 4, and 5
4. Complications is measured using the CRF data that include records of 45 categories of adverse effects at day of discharge
5. Length of hospital stay is measured using hospital records at the day of discharge
6. Number of removed lymph nodes in each station is counted by the pathologist during the final pathological examination of the surgical specimen
Overall trial start date
15/01/2017
Overall trial end date
31/12/2019
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
1. Age ≥18
2. Proven or suspected NSCLC
3. Clinical stage I, II or minimal N2 IIIA, assessed on the basis of CT, PET-CT (except of T1a-b), bronchoscopy and EBUS/EUS (except of T1a-b)
4. General fitness enabling appropriate pulmonary resection (according to the ERS/ESTS guidelines) (both genders are included, this onfo has been given elsewhere in your on-line form)
Participant type
Patient
Age group
Adult
Gender
Both
Target number of participants
500
Participant exclusion criteria
1. History of other malignance (except on non-melanoma skin cancer)
2. Final pathological report of tumour other than NSCLC
3. Final pathological report of carcinoid or salivary gland-type tumour
4. Intraoperative finding of M1 disease
Recruitment start date
30/11/2017
Recruitment end date
30/06/2019
Locations
Countries of recruitment
Austria, China, Germany, Poland, Turkey
Trial participating centre
John Paul II Hospital
Department of Thoracic Surgery
Jagiellonian University
Krakow
31-202
Poland
Trial participating centre
Sun Yat-sen University Cancer Center
Department of Thoracic Surgery
Guangzhou
510060
China
Trial participating centre
Catholic Hospital
Department of Thoracic Surgery
Koblenz
56072
Germany
Trial participating centre
Otto Wagner Hospital
Department of Thoracic Surgery
Vienna
1140
Austria
Trial participating centre
ELK Berlin Chest Hospital
Department of Thoracic Surgery
Berlin
13125
Germany
Trial participating centre
Istanbul University
Department of Thoracic Surgery
Cerrahpasa Medical Faculty
Istanbul
34734
Turkey
Trial participating centre
Thoraxzentrum Ruhrgebiet
Department of Thoracic Surgery
Herne
44651
Germany
Trial participating centre
University of Giessen
Section of Thoracic Surgery, Department of General Surgery
Giesen
35385
Germany
Funders
Funder type
Not defined
Funder name
Uniwersytet Jagielloński w Krakowie
Alternative name(s)
Jagiellonian University in Krakow, Universitas Jagellonica Cracoviensis, UJ
Funding Body Type
private sector organisation
Funding Body Subtype
academic
Location
Poland
Funder name
Sun Yat-sen University Cancer Center
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
Catholic Hospital, Koblenz, Germany
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
Otto Wagner Hospital, Vienna, Austria
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
ELK Berlin Chest Hospital, Berlin, Germany
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
Thoraxzentrum Ruhrgebiet (Germany)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Funder name
University of Giessen
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
The study is planned to be presented during oncological and thoracic surgical conferences, and publication of its results is planned in high-impact peer reviewed journals.
IPD sharing statement:
The datasets generated during and/or analysed during the current study are not expected to be made available due to the legal regulations of patients' data protection. The data will be stored at the John Paul II Hospital, Krakow, Poland.
Intention to publish date
31/12/2020
Participant level data
Not expected to be available
Basic results (scientific)
Publication list