Operative results of non-small cell lung cancer clinically presenting mediastinal lymph adenopathy.
OBJECTIVE
Selection of treatment for operable N2 non-small cell lung cancer (NSCLC) is still controversial. If considered resectable, we have actively performed surgery even for clinical stage IIIA-N2 disease. In this retrospective study, surgical results in NSCLC with clinically presenting mediastinal lymph adenopathy examined to investigate its indication.


METHODS
Consecutive 202 patients who were preoperatively diagnosed or suspected of mediastinal lymph adenopathy and underwent operation were investigated for such as pathological judgement of nodal metastasis, completeness of operation and prognosis. Perioperative chemotherapy and/or radiotherapy was performed in 56 patients.


RESULTS
Pathological diagnosis of nodal status was N0 in 64 patients, N1 in 27, N2 in 104 and N3 in 7. Complete resection was performed in 109 patients (54%). In 111 patients with pathologically proven N2 (pN2), only 40 (36%) were completely resected. The reason of incomplete resection included extranodal extension of mediastinal nodal metastasis in 31 patients, pleural dissemination in 18, extension of primary tumor to mediastinum in 11. Median post-operative survival time was 553 days, and survival rates at 2- and 5-years were 43% and 22%, respectively. In all pN2, survival rates at 2- and 5-years were 33% and 11%, respectively. In 40 patients of completely resected pN2, survival rates at 2- and 5-years were 42% and 22%, respectively, whereas those were 17% and 5% in 64 patients with incompletely resected pN2. The positive effect of perioperative treatment on survival was not apparent.


CONCLUSIONS
If resectable, surgical approach to N2 might be approved, however, extensive examination is required prior to therapy to avoid incomplete resection.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka 812-85825, Japan.
Ichiro
I
Yoshino
Masafumi
M
Yamaguchi
Tomofumi
T
Yohena
Toshifumi
T
Kameyama
Takuro
T
Kometani
Atsushi
A
Osoegawa
Yoshihiko
Y
Maehara
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008206:Lymphatic Diseases / Q000175:diagnosis*; D008207:Lymphatic Metastasis / Q000175:diagnosis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies