Intrathoracic lymph node metastases from extrathoracic carcinoma: the place for surgery.
BACKGROUND
Intrathoracic hilar or mediastinal lymph node metastases (HMLNMs) of extrathoracic carcinomas are infrequent. Their treatment strategy is not established and their prognosis poorly known. We reviewed the place of surgical intervention in their management.


METHODS
Among 565 patients with mediastinal lymph node enlargement, 37 had a history of extrathoracic carcinoma. The enlargement consisted in HMLNMs in 26 (15 men, 11 women), with a mean age of 57.6 (range 19-78) years. Surgical procedures were reviewed.


RESULTS
Diagnostic procedures, comprising mediastinoscopy in 9, anterior mediastinotomy in 2, and video-assisted thoracic surgery (VATS) in 4, were performed mainly because of unresectability due to diffuse and bilateral HMLNMs. Cancer location was breast in 6, kidney or prostate in 2 each, and bladder, rectum, testis, melanoma, and larynx in 1 each. Median survival was 21 months. Resection was performed in 11 patients, comprising posterolateral thoracotomy in 6, muscle sparing thoracotomy in 2, and VATS in 3. Seventeen involved LN stations were removed; of these, primary were kidney in 3, testis or thyroid in 2 each, and larynx, nasopharynx, and intestinum in 1 each. Five-year survival was 41.6% (median, 45 months).


CONCLUSIONS
HMLNMs of extrathoracic carcinoma may be isolated, probably in the context of a particular lymphatic mode of spread. Our experience demonstrates that operation is mainly diagnostic but resection may safely achieve local control of the disease and deserves being advocated in patients with isolated and resectable HMLNMs.
Riquet
Marc
M
Thoracic Surgery Department, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital, Paris, France. marc.riquet@egp.aphp.fr
Berna
Pascal
P
Brian
Emmanuel
E
Badia
Alain
A
Vlas
Claudia
C
Bagan
Patrick
P
Le Pimpec Barthes
Françoise
F
D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D008481:Mediastinoscopy / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult