title: Survival of patients with unsuspected pN2 non-small cell lung cancer after an accurate preoperative mediastinal staging.
abstract: BACKGROUND
  The aim of this study is to analyze the survival of patients with non-small cell lung cancer (NSCLC) without clinical suspicion of mediastinal lymph node involvement who underwent complete resection and whose tumors were finally proven to be pathologic N2 (pN2).
  
  
  METHODS
  This is a retrospective study of a prospective database from January 2004 to December 2010. A total of 621 patients with NSCLC were staged and operated according to the European Society of Thoracic Surgeons guidelines. After exclusions (previous induction treatment, carcinoid tumors, small cell carcinomas), 540 patients were analyzed; 406 (75%) required surgical exploration of the mediastinum and 134 (25%) underwent surgery directly. Survival analysis was performed by the Kaplan-Meier method and the log-rank test was used for comparisons.
  
  
  RESULTS
  Thirty (5.5%) patients had unsuspected pN2 and complete resection was achieved in 27 (90%). Three- and 5-year survival rates were 87% and 81%, respectively, for patients with a true negative result of the protocol (pN0-1), and 79% and 40%, respectively, for those with a false negative result (unsuspected pN2) (p < 0.0001).
  
  
  CONCLUSIONS
  The rate of unsuspected pN2 in patients whose tumors were staged according to the European Society of Thoracic Surgeons guidelines was low. The survival of this group of patients was better than expected. Therefore, resection of properly staged unsuspected pN2 NSCLC is reasonable and should not be avoided if complete resection can be achieved.
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain. Electronic address: carme_obiols@hotmail.com.
authors.forename: Carme
authors.initials: C
authors.lastname: Obiols
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Call
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Rami-Porta
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Trujillo-Reyes
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Roser
authors.initials: R
authors.lastname: Saumench
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Manuela
authors.initials: M
authors.lastname: Iglesias
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Serra-Mitjans
authors.affiliation: Department of Pathology, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Gonzalez-Pont
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Belda-Sanchís
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate