Lymph node dissection as a local control during segmentectomy for small-sized and radiologically solid dominant and...

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Small, solid-dominant, or pure solid nonsmall cell lung cancer (NSCLC) tumors, even when peripherally located, carry a risk of lymph node metastasis.
• Assessing the necessity and efficacy of lymph node dissection during segmentectomy for these specific NSCLC tumor types is crucial for oncological outcomes.

Purpose of the Study:

• To evaluate the validity of lymph node dissection during segmentectomy for oncological local control in patients with small, peripherally located, solid-dominant or pure solid NSCLC.
• To compare lymph node metastasis and recurrence patterns between segmentectomy and lobectomy for these tumor characteristics.

Main Methods:

• A retrospective analysis of 1921 patients with ≤3 cm solid-dominant or pure solid NSCLC and no clinical lymph node involvement was conducted.
• Patients underwent either lobectomy (n=1472) or segmentectomy (n=449) between 2010 and 2020, with a median follow-up of 51.8 months.
• Clinicopathological findings, lymph node distribution, recurrence patterns, and prognosis were analyzed.

Main Results:

• Hilar lymph node metastases were observed in 3% of segmentectomy patients versus 8% of lobectomy patients.
• No hilar lymph node recurrences were noted in the segmentectomy group without distant metastasis.
• Three patients in the lobectomy group experienced hilar lymph node recurrence without distant metastasis.

Conclusions:

• Lymph node dissection during segmentectomy is oncologically adequate for selected small, peripherally located NSCLC tumors.
• Segmentectomy with lymph node dissection offers effective local control for these specific NSCLC cases, comparable to lobectomy in terms of recurrence.
• The findings support the use of segmentectomy with lymph node dissection for appropriate NSCLC patient selection.