Response to "Which Factors Determinate the Lymphadenectomy Definition?"

We would like to thank Chiappetta et al. for their thought-provoking letter and appreciate the opportunity to respond. First, as our data and others have found, sublobar resection is too often associated with inadequate nodal sampling. 1 Heiden B.T. Eaton Jr, D.B. Chang S.H. et al. Assessment of Updated Commission on Cancer Guidelines for Intraoperative Lymph Node Sampling in Early Stage NSCLC. J Thorac Oncol. 2022; 17: 1287-1296 Abstract Full Text Full Text PDF Scopus (8) Google Scholar ,2 Yendamuri S. Dhillon S.S. Groman A. et al. Effect of the number of lymph nodes examined on the survival of patients with stage I non-small cell lung cancer who undergo sublobar resection. J Thorac Cardiovasc Surg. 2018; 156: 394-402 Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar We controlled for the type of resection (e.g., wedge, segmentectomy, lobectomy, etc.) in both the multivariable Cox proportional hazards (overall survival) and cause-specific competing risk (recurrence) models. Nevertheless, these results represent retrospective data, which carries inherent limitations, and the results should be interpreted accordingly. It is also worth noting that the long-awaited JCOG0802—a pivotal trial comparing segmentectomy to lobectomy—was highly unique from real-world practice in that all patients received mandatory systematic or selective lymph node dissection before segmentectomy. 3 Saji H. Okada M. Tsuboi M. et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022; 399: 1607-1617 Abstract Full Text Full Text PDF PubMed Scopus (286) Google Scholar Therefore, we believe that it is critical to emphasize that adequate nodal dissection should be performed even in the setting of sublobar resections. Which Factors Determinate the Lymphadenectomy Definition? Comment on “Assessment of Updated Commission on Cancer Guidelines for Intraoperative Lymph Node Sampling in Early-Stage Non-Small Cell Lung Cancer”Journal of Thoracic OncologyVol. 18Issue 2PreviewWe read with interest the study of Heiden et al.1 about the validation of the new definition of node sampling according to The American College of Surgeons Commission on Cancer, which recommends the resection of at least 10 lymph nodes, belonging to one N1 (hilar) and three N2 (mediastinal) lymph node stations. Full-Text PDF