Analyses of segmental lymph node metastases and intrapulmonary metastases of small lung cancer

Background. Curativity and indications for limited resection of small perip heral lung cancer remain controversial. Methods. Pathologic investigations of segmental lymph node metastases and i ntrapulmonary metastases in the resected lobe were performed for 94 small p eripheral lung cancers (3.0 cm or less in diameter). Results. Nine patients had segmental lymph node metastases, 1 had intrapulm onary metastases, and 1 had both. Of these 11 patients, 5 had metastases li mited to the primary tumor-bearing segments, 2 had metastases in nonprimary tumor-bearing segments, and 4 had metastases in both. Of the 10 patients w ith segmental lymph node metastases, 7 had metastases in both lobar-hilar a nd mediastinal lymph nodes, and 3 of 8 with adenocarcinoma had a tumor 2.0 cm or less. Conclusions. Segmentectomy seems more favorable than wedge resection, but t he risk of remnant tumor remains as compared with lobectomy. Evaluation of lobar-hilar or mediastinal lymph nodes is helpful to determine the presence or absence of segmental lymph node metastases. Limited resection can be un dertaken with smaller tumors to allow preservation of more lung function wh ile accepting a somewhat enhanced risk of recurrence. (Ann Thorac Surg 2000 ;70:1624-8) (C) 2000 by The Society of Thoracic Surgeons.