Commentary: Knowing where to look is half the battle: Nodal dissection for the “screening” era

Central MessageNodal dissection is key to the optimal treatment of lung cancer, but for smaller, part-solid tumors it can be minimized, which will improve the outcome of surgery and minimize problems.See Article page XXX. Nodal dissection is key to the optimal treatment of lung cancer, but for smaller, part-solid tumors it can be minimized, which will improve the outcome of surgery and minimize problems. See Article page XXX. Maniwa and colleagues1Maniwa T. Okami J. Miyoshi T. Wakabayashi M. Yoshioka H. Mimae T. et al.Lymph node dissection in small peripheral lung cancer: supplemental analysis of JCOG0802/WJOG4607L.J Thorac Cardiovasc Surg. 2023; XX: X-XXGoogle Scholar present a post hoc analysis of the seminal segmentectomy versus lobectomy trial for small peripheral lung cancer. It is another key step in our march toward the best operation for these tumors. For those tumors in the study that were part-solid, mediastinal node dissection was unnecessary, as was dissection of nonadjacent segmental nodes. Because 5% of the patients with solid tumors had mediastinal node involvement, a mediastinal node dissection was necessary for those tumors. Regarding systematic versus selective node dissection, the recommendations are more nuanced. For S6 tumors, a full dissection is needed, for others it is not as clear but it appears a selective dissection is reasonable. Before we generalize these results we must be sure they work for Western tumors and the associated histologic differences seen. But such modification of how we perform our surgery will increase the safety, efficiency, and accuracy of our operations. These efforts facilitate multimodal care, which is the hallmark of our unceasing march toward cure. Also, these features underline the differences between our surgical approach from nonoperative treatments such as stereotactic body radiotherapy or ablation. Outpatient segmentectomy with selective or limited node dissection is coming soon and will be a patient-focused advance that appeals to all. The author reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest. Lymph node dissection in small peripheral lung cancer: Supplemental analysis of JCOG0802/WJOG4607LThe Journal of Thoracic and Cardiovascular SurgeryPreviewThe 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. Full-Text PDF