11ip lymph node may play as N2 stage in right middle NSCLC

Abstract

Background Right middle lobe NSCLC has a worse prognosis compared to other lobes possibly due to the lower number of lymph node dissections in surgery.So,we investigate the clinical significance of #11ip lymph node(LN) metastasis in right middle lobe NSCLC.Methods Symbolize the right lung #11 LN as superior 11(#11s), anterior 11(#11ia), and posterior 11(#11ip), based on their adjacency to the superior lobar bronchus, the middle lobar bronchus, and the region between right dorsal segmental bronchus and intermediate bronchus of right lung respectively in the view of single-port thoracoscopic surgery. The clinical data of mediastinal and #11 LN metastasis in 80 cases of right middle lobe NSCLC who were underwent surgical pulmonary resection from 2015–2022 were analyzed retrospectively and one case of #11ip LN metastasis retrogradely from #7 LN in bladder cancer was reported.Results None of 32 patients with pure ground-glass nodule (pGGN) were found to have lymph node metastasis (LNM). Out of the 48 patients with mixed ground-glass nodule (mGGN), no case with #11ip LNM was found in N1 cases(n = 6), but there was one case of #11ip LNM in N2 cases(n = 6).This tumor was in lateral segment and > 2 cm. #11ip LN resection with undifferentiated dorsal oblique fissure need more operative time than those with differentiated dorsal oblique fissure(149.32m to109.68m,p < 0.05) ,but postoperative drainage extubation time has no difference(5.22 days to 4 days,p = 0.116) and the postoperative drainage volume has no difference either (823.33ml to 607.14ml,p = 0.100). In addition, the survival period of N2 patient with #11ip LNM is 6 months.Conclusion To right middle lobe NSCLC with pGGN, #11ip LN dissection or biopsy is not necessary.Presenting as mGGN, #11ip LN should be dissected or biopsied particularly #4 or #7 LNM were found during surgery. #11ip LNM has a worse prognosis and may play as N2 stage in right middle lobe NSCLC.