title: Is the lymphatic drainage of lung cancer lobe-specific? A surgical appraisal.
abstract: OBJECTIVE
  Nowadays, early-stage lung cancers are more frequently encountered. Selective lymph node (LN) dissection based on lobe-specific lymphatic pathway has been proposed. Our aim was to study nodal involvement according to tumour location.
  
  
  METHODS
  We reviewed 1779 lobectomized patients and analysed their pathological characteristics according to tumour location: Group 1 (G1), right upper lobe; Group 2 (G2), right middle lobe; Group 3 (G3), right lower lobe; Group 4 (G4), left upper division; Group 5 (G5), lingula; Group 6 (G6), left lower lobe. The pN status was recorded for each group to analyse the lymphatic spread of non-small-cell lung cancer (NSCLC) according to tumour location.
  
  
  RESULTS
  The numbers and proportions of lobectomies in each group were 613 patients in G1 (59.2%), 64 in G2 (6.4%), 359 in G3 (34.6%), 404 in G4 (54.3%), 54 in G5 (7.3%) and 286 in G6 (38.4%). The rates of pN2 involvement were similar, whatever the group was, even when deciphering single- and multistation diseases. on the right side, single-station N2 disease was mainly found in the superior mediastinum (SM) for G1 (95%), and in the inferior for G3 (90%). On the left side, single-station N2 was mainly found in the SM in G4 (94%), and the inferior in G6 (48%). Whatever the side, in case of two-station involvement, both mediastina were concerned in 40% (in G4) to 81% of the case (in G3). Long-term survival rates were different in skip metastasis, single- and multistation involvement, but not between lobes.
  
  
  CONCLUSIONS
  Tumour location is not a predictor of nodal metastasis pattern. In surgical treatment of NSCLC, complete systematic mediastinal LN dissection remains the only acceptable procedure from an oncological point of view.
authors.affiliation: Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France marc.riquet@egp.aphp.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
authors.affiliation: Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rivera
authors.affiliation: Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Ciprian
authors.initials: C
authors.lastname: Pricopi
authors.affiliation: Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Alex
authors.initials: A
authors.lastname: Arame
authors.affiliation: Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mordant
authors.affiliation: Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Foucault
authors.affiliation: Department of General Thoracic Surgery, Cedar Surgical Centre, Bois-Guillaume, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Dujon
authors.affiliation: Department of General Thoracic Surgery, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Le Pimpec-Barthes
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008482:Mediastinum / Q000601:surgery; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies
keywords: Lobectomy; Lung cancer; Lymph node dissection; Lymphatic drainage; Mediastinum