J.Jpn. Surg. Soc.. 127(1): 58-63, 2026

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Feature topic

LYMPH NODE DISSECTION DURING SEGMENTECTOMY IN SMALL-SIZED NON-SMALL CELL LUNG CANCER

The Japan Clinical Oncology Group (JCOG) and West Japan Oncology Group (WJOG) jointly conducted the JCOG0802/WJOG4607L trial, which found that segmentectomy was superior to lobectomy in terms of overall survival in patients with small peripheral non-small cell lung cancer (NSCLC). Therefore, segmentectomy has become the standard surgical procedure for this patient population. In the JCOG0802/WJOG4607L trial, mediastinal lymph node dissection (LND) was mandatory in both the lobectomy and segmentectomy groups. While LND has been widely accepted in lobectomy since Cahan reported “radical lobectomy” in 1960, the optimal extent and anatomic regions of LND during segmentectomy remain unclear.
The purposes of LND are to ensure local disease control and provide accurate staging. In the JCOG0802/WJOG4607L trial, 65 of 1,106 patients (5.9％) had lymph node metastases, 12 (1.1％) experienced ipsilateral hilar lymph node recurrence, and 30 (2.7％) had ipsilateral mediastinal lymph node recurrence. More recently, adjuvant therapies, including immune checkpoint inhibitors and epidermal growth factor receptor tyrosine kinase inhibitors, have been shown to improve disease-free survival in patients with stage II or III NSCLC. However, LND increases operative time, blood loss, and postoperative complications. Therefore, determining the optimal extent of LND during segmentectomy in NSCLC is essential.

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