title: Surgery for non-small cell lung cancer with unsuspected metastasis to ipsilateral mediastinal or subcarinal nodes (N2 disease).
abstract: OBJECTIVE
  Although the results after surgery for N2 disease are disappointing, there seems to be a subgroup of patients which may benefit from primary resection. These patients have clinically unrecognized N2 involvement that is discovered only at the time of thoracotomy (unsuspected or unforeseen N2 disease). It was the aim of this retrospective study to analyze the survival after resection for unforeseen N2 disease and to evaluate different prognostic factors. We were interested to see whether our strategy of rigorous staging of the mediastinum with mediastinoscopy or anterior mediastinotomy had an effect on the resectability rate and survival of unsuspected N2 disease.
  
  
  METHODS
  Between 1985 and 1990, 859 patients with potentially operable non-small cell lung cancer were referred to our surgical department. Despite rigorous preoperative staging with computed tomography scan and cervical mediastinoscopy and/or anterior mediastinotomy, 103 patients (14.5%) had unsuspected N2 disease at thoracotomy. The tumor could be completely resected in 90 patients (87.5%).
  
  
  RESULTS
  The 5-year survival after complete resection was 22%. Histology of the tumor, number of involved levels and extent of nodal disease had no effect on survival.
  
  
  CONCLUSIONS
  We conclude that resection is justified in patients with unforeseen N2 disease. Rigorous staging of the mediastinum by cervical mediastinoscopy or anterior mediastinotomy results in a high resectability rate and avoids unnecessary thoracotomies. Mediastinoscopy plays a central role in the staging of patients with carcinoma of the lung.
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: De Leyn
authors.forename: P
authors.initials: P
authors.lastname: Schoonooghe
authors.forename: G
authors.initials: G
authors.lastname: Deneffe
authors.forename: D
authors.initials: D
authors.lastname: Van Raemdonck
authors.forename: W
authors.initials: W
authors.lastname: Coosemans
authors.forename: J
authors.initials: J
authors.lastname: Vansteenkiste
authors.forename: T
authors.initials: T
authors.lastname: Lerut
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D015996:Survival Rate