• Tomohiro Maniwa, Jiro Okami, Tomohiro Miyoshi, Masashi Wakabayashi, Hiroshige Yoshioka, Takahiro Mimae, Makoto Endo, Aritoshi Hattori, Kazuo Nakagawa, Tetsuya Isaka, Mitsuhiro Isaka, Ryosuke Kita, Yuta Sekino, Noriko Mitome, Keiju Aokage, Hisashi Saji, Ryu Nakajima, Morihito Okada, Masahiro Tsuboi, Hisao Asamura, Haruhiko Fukuda, Shun-Ichi Watanabe, and West Japan Oncology Group and Japan Clinical Oncology Group.
• Department of Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan.
• J. Thorac. Cardiovasc. Surg. 2024 Sep 1; 168 (3): 674683.e1674-683.e1.

ObjectiveThe optimal region of lymph node dissection (LND) during segmentectomy in patients with small peripheral non-small cell lung cancer requires clarification. Through a supplemental analysis of the Japan Clinical Oncology Group (JCOG) 0802/West Japan Oncology Group (WJOG) 4607L, we investigated the associated factors, distribution, and recurrence pattern of lymph node metastases (LNMs) and proposed the optimal LND region.MethodsOf the 1106 patients included in the JCOG0802/WJOG4607L, 1056 patients with LNDs were included in this supplemental analysis. We investigated the distribution and recurrence pattern of LNMs along with the radiologic findings (with ground-glass opacity, part-solid tumor; without ground-grass opacity component, pure-solid tumor).ResultsThe radiologic findings were the only significant factor for LNMs. Of 533 patients with part-solid tumors, 8 (1.5%) had LNMs. Further, only 3 (0.5%) patients had pN2 disease, and no patients had interlobar LNMs from nonadjacent segments. Of the 523 patients with pure-solid tumors, 55 (10.5%) had LNMs, and 28 (5.4%) had pN2 disease. Five patients had metastases to nonadjacent interlobar lymph nodes (LNs). Two (2.0%) patients with S6 tumors had upper mediastinal LNMs. In addition, the incidence of mediastinal LN recurrence in patients with S6 lung cancer was greater in those who underwent selective LND than those who underwent systematic LND (P = .0455).ConclusionsNonadjacent interlobar and mediastinal LND have little impact on pathologic nodal staging in patients with part-solid tumors. In contrast, selective LND is recommended at least for patients with pure-solid tumors.Copyright © 2023 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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