原発性肺癌に対するリンパ節郭清術：その意義，歴史的変遷と今後の将来

Since Cahan proposed “radical lobectomy” in 1960, lobectomy or larger lung resection with regional hilar and mediastinal lymph node dissection has been globally recognized as a standard mode of surgery for non-small cell lung cancer (NSCLC). Systematic nodal dissection (SND), which involves the removal of mediastinal nodes from the superior to the inferior mediastinum compartmented by anatomical landmarks, has remained a standard mode mediastinal nodal dissection, irrespective of the tumor location. However, since the late 1990s, with the elucidation of the nodal spread pattern, we have included lobe-specific nodal dissection (LND) in our clinical practice. The indications for LND vary depending on institutions; however, the LND is currently a major mode of dissection, especially in Japan. An prospective trial is currently underway to evaluate the validity and clinical benefit of LND in comparison to SND. Recently, limited lung resection without lymph node dissection is indicated, especially for early lung adenocarcinoma with ground glass attenuation-dominant nodules. The improvement of imaging modalities and new technologies, including radiomics and deep learning will enable us to precisely predict the nodal status before surgery. In the near future, lymph node dissection will be more sophisticated and personalized than ever before. This review article outlines the clinical benefit, history, and future perspectives of lymph node dissection for operable NSCLC.