The new strategy of selective nodal dissection for lung cancer based on segment-specific patterns of nodal spread

A new strategy for selective nodal dissection in non-small cell lung cancer (NSCLC) patients according to the segment of primary tumor was explored. Data on 504 patients with NSCLC of less than 5 cm, histologically revealed to be N2 disease after thoracotomy, were analyzed. In right upper lobe (RUL) tumor, when the pretracheal node was negative, the incidence of subcarinal involvement was 3.8%. In lower lobe tumor, superior segment (RLL-Superior and LLL-Superior) tumor showed a significantly higher incidence of superior mediastinal involvement than basal segment (RLL-Basal and LLL-Basal) tumor (right, P=0.0036; left, P=0.0499). When the subcarinal node was negative, the incidence of superior mediastinal metastasis in RLL-basal and LLL-Basal tumor was 11% and 8%, respectively. In left upper lobe tumor, superior segment (LUL-Superior) tumor showed a significantly lower incidence of subcarinal involvement than lingular segment (LUL-Lingular) tumor (P=0.0381). When aortic nodes were negative in LUL-Superior tumor, the incidence of subcarinal metastasis was 6%. Collectively, in RUL and LUL-Superior tumors, subcarinal dissection may be unnecessary if superior mediastinal node is negative. In RLL-Superior and LLL-Superior tumors, extensive dissection is required. In RLL-Basal and LLL-Basal tumors, superior mediastinal dissection may be unnecessary if subcarinal node is negative.