Extent of Lymph Node Dissection in Patients with Small-Sized Peripheral Non-Small Cell Lung Cancer during Intentional Segmentectomy.

Abstract

Segmentectomy and mediastinal lymph node dissection (MLND) are becoming standard procedures for small-sized (<2 cm) peripheral non-small cell lung cancer (NSCLC). Although the benefits of the less resected lung are proven, the extent of lymph node dissection remains unchanged. We studied 422 patients who underwent lobectomy with MLND (lobe specific or systemic) for small peripheral NSCLC with clinical N0 disease. Patients with middle lobectomy (n = 39) and a consolidation-to-tumor (C/T) ratio ≤0.50 (n = 33) were excluded. We investigated the clinical factors, lymph node metastasis distributions, and lymph node recurrence patterns of 350 patients. Thirty-five (10.0%) patients had lymph node metastasis; none with C/T ratio <0.75 had lymph node metastasis and lymph node recurrence. None had solitary lymph node metastasis in the outside lobe-specific MLND. Six patients had mediastinal lymph node metastasis at the initial site of recurrence; none had mediastinal lymph node recurrence outside the lobe-specific MLND, except for two patients with S6 primary disease. NSCLC patients with small peripheral tumors and a C/T ratio <0.75 during segmentectomy may not require MLND. The optimal MLND for patients with a C/T ratio ≥0.75, except for those with S6 primary, may be lobe-specific MLND.