[Metastases to the mediastinal lymph nodes in lung cancer and their extensive dissection].
OBJECTIVE
To study the metastatic frequency, distribution and feature of mediastinal nodes in lung cancer and to establish criteria for nodal dissection.


METHODS
Clinical data of 386 patients who underwent resection of lung cancers in the past 9 years were analyzed retrospectively. Based on the distribution map of mediastinal lymph nodes developed by Naruke, ipsilateral hilar and mediastinal nodes were resected.


RESULTS
147 cases (38.1%) had mediastinal nodal involvement (N2). A total of 289 groups of nodes were dissected. The rate of N2 disease among squamous-cell, adeno-, small-cell and large-cell carcinomas was 30.1%, 44.1%, 48.0% and 50.0%, respectively. In 71 cases with N2 disease in the upper lobes, 146 groups of N2 nodes were resected, including 124 groups in the upper mediastinum (84.9%) and 22 groups in the lower mediastinum (15.1%). In 76 cases with N2 nodes in the lower and middle lobes, 143 groups of N2 nodes were dissected, including 76 groups in the upper mediastinum (53.1%) and 67 groups in the lower mediastinum (46.9%). Saltatory metastases occurred in 79 patients, accounting for 53.7% of N2 nodes and in 16 cases that occurred in the mediastinum (10.9%).


CONCLUSIONS
The feature of mediastinal lymph node metastases in lung cancer may be saltatory and multiple. Cure can be achieved only after extensive dissection of the upper and lower mediastinal nodes.
Li
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Y
Department of Thoracic Surgery, First Affiliated Clinical Hospital, China Medical University, Shenyang.
Li
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H
Hu
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Y
D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D018288:Carcinoma, Small Cell / Q000556:secondary / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D012189:Retrospective Studies