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Background  Although lobe‐specific nodal spread of primary lung cancer has been recently described, segment‐specific nodal spread remains unclear. We investigated the frequency of hailer and mediastinal lymph node involvement and survival in patients with tumors located in the superior segment ( SS ) and basal segment ( BS ) in the right lower lobe.    Methods  Two hundred and sixty‐three patients with primary lung cancer originating in the right lower lobe underwent lobectomy with systematic mediastinal lymph node dissection. Patients were categorized into two groups:  SS  (n = 114) or  BS  (n = 149).    Results  Frequencies of metastasis to station 11s and 11i were significantly higher in the  SS  ( P  < 0.0001) and  BS  groups ( P  = 0.022), respectively. Both the  SS  and  BS  groups showed a high frequency of subcarinal mediastinal zone (station 7) metastasis (96.9% and 90.6%, respectively;  P  = 0.271). The frequencies of superior mediastinal zone (station 2 R  and 4 R ) metastasis were 37.5% in the  SS  and 35.8% in the  BS  group ( P  = 0.878). In patients with pN2 disease, three‐year disease‐free survival was significantly shorter in the  SS  (22.6%) than the  BS  group (42.1%;  P  = 0.020). In the  BS  group, the independent predictive factors of a poor or good prognosis were metastasis to station 11i or skip metastasis, respectively; however, we did not detect an independent prognostic factor in the  SS  group. In the right lower lung lobe, there was no segment‐specific nodal spread.    Conclusion  When segmentectomy is undertaken, mediastinal lymph node dissection should be performed in proportion to lobectomy.

Prognosis and segment‐specific nodal spread of primary lung cancer in the right lower lobe