Suzuki Yota, Dhupar Rajeev, Sarkaria Inderpal S, Christie Ian G, Mazur Summer N, Pennathur Arjun, Luketich James D, Levy Ryan M, Landreneau Rodney J, Schuchert Matthew J
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Cardiothoracic Surgery, Wake Forest University, Winston-Salem, North Carolina.
JTO Clin Res Rep. 2025 Jun 13;6(8):100861. doi: 10.1016/j.jtocrr.2025.100861. eCollection 2025 Aug.
Besides the discussion on parenchymal margin, data on the extent of lymph node (LN) dissection are scarce, especially in segmentectomy. This study aimed to investigate the extent of LN dissection and detection of occult disease in segmentectomy compared with lobar resection.
We performed a single-institution, retrospective analysis for patients who underwent segmentectomy or lobectomy for clinical T1N0M0 (≤3 cm) NSCLC from 2012 to 2022. The extent of LN dissection and the rate of detection of occult LN disease were compared. N1 nodes were further classified as collected as a specimen during the operation (N1 dissection) and the nodes retrieved from lung specimens by pathologists (N1 lung specimen).
During the study period, 957 lobectomies and 402 segmentectomies were performed for clinical T1N0M0 NSCLC. The median number of sampled LNs was significantly higher in the lobectomy group (18 versus 12; < 0.001). This tendency was similar across all node groups, including N2 nodes (7 versus 5), N1 dissection nodes (6 versus 4), and most significantly N1 lung specimen nodes (4 versus 0; all < 0.001) There was a significant difference in N1 occult nodes (13.3% versus 3.7%; < 0.001), whereas the difference was not significant in N2 occult nodes (5.5% versus 3.2%; = 0.074).
Segmentectomy was associated with less LN sampling, which translated into lower detection of occult nodal metastasis in N1 LNs. Although standardized pathologic dissection could potentially improve detection, there is likely an inevitable inferiority in LN sampling with segmentectomy.
除了对实质边缘的讨论外，关于淋巴结（LN）清扫范围的数据很少，尤其是在肺段切除术中。本研究旨在探讨与肺叶切除相比，肺段切除术中LN清扫的范围及隐匿性疾病的检出情况。
我们对2012年至2022年因临床T1N0M0（≤3 cm）非小细胞肺癌（NSCLC）接受肺段切除术或肺叶切除术的患者进行了单机构回顾性分析。比较了LN清扫范围和隐匿性LN疾病的检出率。N1淋巴结进一步分为手术中作为标本收集的（N1清扫）和病理学家从肺标本中检出的淋巴结（N1肺标本）。
在研究期间，对临床T1N0M0 NSCLC患者进行了957例肺叶切除术和402例肺段切除术。肺叶切除术组的采样LN中位数显著更高（18个对12个；<0.001）。在所有淋巴结组中这种趋势相似，包括N2淋巴结（7个对5个）、N1清扫淋巴结（6个对4个），最显著的是N1肺标本淋巴结（4个对0个；均<0.001）。N1隐匿性淋巴结存在显著差异（13.3%对3.7%；<0.001），而N2隐匿性淋巴结差异不显著（5.5%对3.2%；=0.074）。
肺段切除术相关的LN采样较少，这导致N1淋巴结中隐匿性淋巴结转移的检出率较低。尽管标准化病理清扫可能会提高检出率，但肺段切除术的LN采样可能不可避免地存在劣势。
