Non-adjacent interlobar lymph node metastasis distant from small-sized peripheral non-small cell lung cancer

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Optimal lymph node dissection (LND) extent during lung segmentectomy remains unclear.
• Dissecting non-adjacent interlobar lymph nodes (non-aiLNs) during segmentectomy poses technical challenges.
• Assessing the necessity of non-aiLN dissection is crucial for refining surgical techniques.

Purpose of the Study:

• To determine if non-adjacent interlobar lymph node dissection is required during intentional lung segmentectomy.
• To evaluate the clinical significance of non-aiLN metastasis in non-small cell lung cancer (NSCLC) patients undergoing segmentectomy.

Main Methods:

• Retrospective cohort study of 310 NSCLC patients who underwent lobectomy and mediastinal LND.
• Analysis of lymph node metastasis distribution, focusing on non-aiLNs.
• Inclusion criteria: NSCLC ≤ 2 cm, surgery between January 2006 and December 2015.

Main Results:

• Six patients (1.9%) had interlobar lymph node (iLN) metastasis.
• No iLN metastasis was found in primary lesions located in the right upper lobe or left upper segment.
• Of the six patients with iLN metastasis, three had non-aiLN metastasis, associated with larger tumors (≥15 mm) and high PET SUV values (>3.5).

Conclusions:

• Non-adjacent interlobar lymph node dissection may not be necessary for segmentectomy of the right upper lobe or left upper segment.
• Consider non-adjacent interlobar lymph node dissection for lower-lobe segmentectomies.
• This finding aids in optimizing surgical strategies for NSCLC segmentectomy.