Lymphadenectomy During Sublobar Resections

Abstract

Lymph node dissection is necessary for adequate staging of the patient, and it facilitates dissection of vessels and bronchi. The American College of Surgeons Commission on Cancer recommends lymph node removal from three mediastinal and one hilar lymph node station (American College of Surgeons Commission on Cancer. Optimal Resources for Cancer Care. Published online February 2021. https://www.facs.org/-/media/files/quality-programs/cancer/coc/optimal_resources_for_cancer_care_2020_standards.ashx). Since the publication of the ACOSOG Z0030 trial, the need for full lymph node dissection compared to lymph node sampling remains controversial (Darling et al., J Thorac Cardiovasc Surg 141:662–670, 2011). In our practice, we perform complete lymph node dissection for all lung cancer malignancies with the exception of small ground glass opacities (GGO). In this chapter, we will demonstrate how we dissect mediastinal, hilar, lobar, segmental lymph nodes. Metastasis in mediastinal nodes is usually lobe-specific, thus, 4R dissection is recommended in right upper lobe segmentectomies, preaortic and aortopulmonary window dissection (levels 5 and 6) in left upper lobe segmentectomies, and inferior pulmonary (level 9) in both sides of lower lobes. We routinely perform subcarinal dissection (level 7) for any segmentectomy.