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Thoracoscopic Extended Right Middle Plus Lower Sleeve Lobectomy for Non-Small-Cell Lung Cancer
Published on: February 27, 2026
Rethinking pN1 Disease in Non-Small Cell Lung Cancer: Anatomical Subclassification, Surgical Extent, and Survival
Eyüp Halit Yardımcı1, Aleyna Gültekin Arıdaş1, Sezer Aslan1
1Thoracic Surgery Department, School of Medicine, Marmara University, 34854 Istanbul, Turkey.
Journal of Clinical Medicine
|May 27, 2026
Summary
Anatomical location of N1 metastasis, not nodal burden, impacts survival in non-small cell lung cancer (NSCLC). Peripheral N1 involvement offers better outcomes than hilar/interlobar disease, suggesting standard lobectomy is sufficient.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Pathological N1 (pN1) non-small cell lung cancer (NSCLC) exhibits variable survival.
- Current TNM staging lacks N1 subclassification, overlooking anatomical location's prognostic value.
- Optimal surgical extent for pN1 NSCLC, particularly with hilar/interlobar involvement, remains uncertain.
Purpose of the Study:
- To investigate the prognostic impact of anatomical N1 station location in pN1 NSCLC.
- To determine if nodal burden or anatomical site is a more significant predictor of survival.
- To evaluate the necessity of extended resections versus standard lobectomy for different pN1 subgroups.
Main Methods:
- Retrospective analysis of 150 pN1 NSCLC patients undergoing curative-intent resection and nodal dissection (2012-2023).
- Analysis of clinicopathological variables including anatomical N1 level, nodal count, tumor characteristics, and surgical extent.
- Survival outcomes assessed through long-term follow-up until March 2026.
Main Results:
- Peripheral N1 involvement (stations 12-14) correlated with significantly longer survival than hilar/interlobar metastasis (stations 10-11) (p=0.019).
- Nodal count and multiple-station involvement did not significantly affect survival.
- Age and station 11 pN1 positivity were independent negative prognostic factors; extended resections showed no benefit and worsened outcomes in hilar/interlobar disease.
Conclusions:
- The anatomical location of N1 metastasis is a critical prognostic factor in pN1 NSCLC.
- Standard lobectomy appears adequate for all pN1 subgroups, including hilar/interlobar disease.
- Extended resections do not improve survival; further research on adjuvant therapies is warranted.