title: Lobe-specific mediastinal nodal dissection is sufficient during lobectomy by video-assisted thoracic surgery or thoracotomy for early-stage lung cancer.
abstract: BACKGROUND
  Lobectomy with complete mediastinal lymphadenectomy is considered standard for patients with early-stage non-small cell lung cancer (NSCLC). However, the benefits of complete lymphadenectomy are unproven. There is evidence suggesting a predictable pattern of mediastinal nodal drainage. This study analyzed the frequency and pattern of mediastinal nodal disease and its impact on outcome in patients with early-stage NSCLC.
  
  
  METHODS
  Patients with clinical N0/N1 NSCLC staged with CT scans and PET scans were identified. Disease involvement of resected nodal stations was recorded. Patterns of recurrence in patients who underwent lobectomy with complete mediastinal systematic lymph node sampling (SLNS) were compared with those who underwent lobe-specific mediastinal SLNS.
  
  
  RESULTS
  From July 2004 to April 2011, 370 patients were identified. Complete SLNS was performed in 282 patients. Fifteen patients (5.3%) in the group with complete SLNS were found to have N2 disease after pathologic evaluation. Patients with left-sided tumors were more likely to have pathologic N2 disease than were patients with right-sided tumors (P = .03). Only one patient (0.36%) had positive N2 disease in the distal mediastinum while skipping lobe-specific mediastinal nodes. In addition, patients with complete SLNS had a rate of recurrence similar to that of the group that had lobe-specific mediastinal evaluation (20.6% vs 18.2%, P = .68).
  
  
  CONCLUSIONS
  Mediastinal N2 metastases follow predictable lobe-specific patterns in patients with negative preoperative CT scans and PET scans. Lobe-specific N2 nodal evaluation results in a recurrence rate similar to that of complete mediastinal evaluation. Lobe-specific mediastinal nodal evaluation appears acceptable in patients with early-stage NSCLC.
authors.affiliation: Division of Thoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Mark
authors.initials: M
authors.lastname: Shapiro
authors.affiliation: Division of Thoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Sagar
authors.initials: S
authors.lastname: Kadakia
authors.affiliation: Division of Thoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: James
authors.initials: J
authors.lastname: Lim
authors.affiliation: Division of Thoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Andrew
authors.initials: A
authors.lastname: Breglio
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mount Sinai Medical Center, New York, NY.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
authors.affiliation: Division of Thoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kaufman
authors.affiliation: Division of Thoracic Surgery, Mount Sinai Medical Center, New York, NY.
authors.forename: Dong-Seok
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Division of Thoracic Surgery, Mount Sinai Medical Center, New York, NY. Electronic address: raja.flores@mountsinai.org.
authors.forename: Raja M
authors.initials: RM
authors.lastname: Flores
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D009518:New York / Q000453:epidemiology; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome