Does anatomical segmentectomy allow an adequate lymph node (N) staging for NSCLC?

Background: Anatomical segmentectomy is again under evaluation for cure of T1 N0 NSCLC. Whether segmentectomy does permit or not an adequate resection of nodal stations for staging or cure is still pending. Methods: We compared 36 (67% male) anatomical segmentectomies (S) and 58 (76% male) lobectomies (L), performed for T ≤ 2cm N0 M0 at the preoperative work up. Dissection of N stations number 4/5/6/7 was identical in (S) and (L), stations number 10, 11 and 12 with the segmental 13 were also dissected carefully during (S). Results: Number and type of surgical procedures, histology, p Stage, follow up are detailed in table 1.The mean size of the resected lesions was 1.7 ± 0.7 cm in (S) and 1.8 ± 0.47 cm (p=0.409) in (L). (S) resection margins were free in 100%. Mean number of dissected lymph nodes was 9.6 ± 3.4 in (S) compared to 17 ± 7 in (L) (p=0.001), for N1 it was 5 ± 1.8 in (S) versus 10.2 ± 4.2 in (L) (p=0.001), for N2 was 5.2 ± 2.9 in (S) versus 6.8 ± 4.7 in (L) (p=0.078). In (S) 100% was N0, in (L) 86,4% was N0, 6.8% N1, 6.8%N2 (4pts ). Actuarial 24 months free from recurrence survival was 100% for (S) and 96% for (L) , p=0.889). Conclusions: If compared to standard lobectomy, anatomical segmentectomy for T ≤ 2cm N0, NSCLC provides a lower number of N1 and the same number of N2 nodes for pathological examination, 7% of patients may be under-staged (for N1), but the 24 months free from recurrence survival is equivalent.