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Related Experiment Video

Updated: Jun 26, 2026

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery
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Occult Node Detection With Lobectomy Versus Segmentectomy for Stage IA NSCLC.

Yota Suzuki1, Rajeev Dhupar2, Inderpal S Sarkaria3

  • 1Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

JTO Clinical and Research Reports
|August 14, 2025
PubMed
Summary

Segmentectomy lung cancer surgery involves less lymph node (LN) sampling than lobectomy, leading to fewer occult N1 nodal metastases detected. Standardized dissection may help, but segmentectomy has inherent limitations in LN sampling.

Keywords:
Lymph node dissectionNSCLCSegmentectomy

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Area of Science:

  • Thoracic Surgery
  • Surgical Oncology
  • Pulmonary Medicine

Background:

  • Lymph node (LN) dissection extent is crucial in non-small cell lung cancer (NSCLC) staging.
  • Data on LN dissection in segmentectomy for NSCLC is limited compared to lobectomy.

Purpose of the Study:

  • To compare the extent of lymph node dissection and occult disease detection between segmentectomy and lobectomy for clinical T1N0M0 NSCLC.
  • To evaluate the impact of surgical approach on lymph node staging in early-stage NSCLC.

Main Methods:

  • Retrospective analysis of 957 lobectomies and 402 segmentectomies for clinical T1N0M0 NSCLC (2012-2022).
  • Comparison of median lymph node counts and occult N1/N2 nodal metastasis detection rates.
  • Classification of N1 nodes into intraoperative dissection and lung specimen retrieval.

Main Results:

  • Lobectomy yielded significantly more sampled LNs (18 vs 12) and N1 lung specimen nodes (4 vs 0) than segmentectomy (p < 0.001).
  • Occult N1 nodal metastasis was detected more frequently in lobectomy (13.3% vs 3.7%; p < 0.001).
  • No significant difference in N2 occult nodal metastasis detection (5.5% vs 3.2%; p = 0.074).

Conclusions:

  • Segmentectomy is associated with reduced lymph node sampling and lower detection of occult N1 nodal metastasis.
  • Standardized pathologic dissection may improve detection rates but segmentectomy likely has inherent limitations in LN sampling.
  • These findings highlight potential understaging of nodal disease with segmentectomy in NSCLC.