Limited mediastinal lymph node dissection for non-small cell lung cancer according to intraoperative histologic examinations.
BACKGROUND
Although radioisotopic procedures are commonly used to detect sentinel lymph nodes in breast cancer surgery, these procedures are often problematic and not necessarily suitable for lung cancer surgery.


METHODS
Our previous study revealed that the mediastinal sentinel lymph node, defined as the regional mediastinal lymph node, consisted of nodes 2, 3, or 4 in right upper lobe cancers; 3, 7, or 8 in right lower lobe cancers; 4, 5, or 7 in left upper lobe cancers; and 4, 7, or 8 in left lower lobe cancers. On the basis of these findings, we pathologically investigated one representative lymph node at each of the 3 levels dissected during surgical intervention in 69 patients with non-small cell lung cancer from September 1993 through December 2002. Fifty-eight patients with lung cancer underwent lobectomies with limited mediastinal lymph node dissection according to this strategy.


RESULTS
Mediastinal lymph node recurrence was observed in only one patient during 41 +/- 25 months (maximum, 98 months) of follow-up. The cancer-specific 5-year survivals were 96.6% in patients with pathologic stage IA disease (n = 31) and 67.4% in patients with stage IB disease (n = 16).


CONCLUSIONS
These results suggested that limited mediastinal lymph node dissection is applicable to patients with non-small cell lung cancer whose regional mediastinal lymph nodes are not metastatic.
Yoshimasu
Tatsuya
T
Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Japan. yositatu@mail.wakayama-med.ac.jp
Miyoshi
Shinichiro
S
Oura
Shoji
S
Hirai
Issei
I
Kokawa
Yozo
Y
Okamura
Yoshitaka
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D011013:Pneumonectomy; D011446:Prospective Studies; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D016019:Survival Analysis