Under the command of Lieutenant General Kenji Doihara, the division participated in the Beiping–Hankou Railway Operation and in the Northern and Eastern Honan campaign including the Battle of Lanfeng.

In July 1938, Sano was promoted to major general and transferred to command the IJA 4th Heavy Field Artillery Brigade.

Two battalions from Sano's division were delivered to Guadalcanal by Tokyo Express missions in October 1942 and participated in the Battle for Henderson Field, which resulted in a decisive defeat for the Japanese forces.

[5] In November 1942, Tokyo Express missions delivered the 38th Division's 228th Infantry Regiment to Guadalcanal along with Sano and his staff.

[6] After returning to Rabaul with his troops, Sano was reassigned to Japan and assigned as Chief of Staff of the General Defense Command (GDC) in June 1943.

Afterwards, it was transferred to the operational control of the Japanese Sixth Area Army, and continued in its role as a garrison force for Wuhan and the surrounding region.