title: Unexpected lymph node disease in resections for pulmonary metastases.
abstract: BACKGROUND
  Pulmonary metastasectomy is widely accepted for different malignant diseases. The role of mediastinal lymph node (LN) dissection in these procedures is discussed controversially. We evaluated our results of LN removal at the time of pulmonary metastasectomy with respect to the frequency of unexpected LN disease.
  
  
  METHODS
  This was a retrospective analysis of 313 resections performed in 209 patients. Operations were performed in curative intention. Patients with known thoracic LN involvement and those without lymphadenectomy (n = 43) were excluded. Patients were analyzed according the type of LN dissection. Subgroups of different primary cancers were evaluated separately.
  
  
  RESULTS
  Sublobar resections were performed in 256 procedures with lymphadenectomy, and 14 patients underwent lobectomy. Patients underwent radical lymphadenectomy (n = 158) or LN sampling (n = 112). The overall incidence of unexpected tumor in LN was 17% (radical lymphadenectomy, 15.8%; sampling, 18.8%). Unexpected LN involvement was found in 17 patients (35.5%) with breast cancer, in 120 (9.2%) with colorectal cancer, and in 53 (20.8%) with renal cell carcinoma. The 5-year survival was 30.2% if LN were tumor negative and 25% if positive (p = 0.19). LN sampling vs radical removal had no significant effect on 5-year survival (23.6% vs 30.9%; p = 0.29).
  
  
  CONCLUSIONS
  Dissection of mediastinal LN in resection of lung metastases will reveal unexpected LN involvement in a relevant proportion of patients, in particular in breast and renal cancer. Routine LN dissection appears necessary and may become important for further therapeutic decisions. On the basis of our data, LN sampling seems to be sufficient.
authors.affiliation: Department of Thoracic and Vascular Surgery, Klinik Löwenstein, Löwenstein, Germany.
authors.forename: Gernot
authors.initials: G
authors.lastname: Seebacher
authors.affiliation: Department of Thoracic and Vascular Surgery, Klinik Löwenstein, Löwenstein, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Decker
authors.affiliation: Department of Oncology, Klinik Löwenstein, Löwenstein, Germany.
authors.forename: Jürgen R
authors.initials: JR
authors.lastname: Fischer
authors.affiliation: Department of Internal Medicine, Respiratory Disease and Cardiology, Missionsärztliche Klinik, Würzburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Held
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
authors.affiliation: Department of Thoracic and Vascular Surgery, Klinik Löwenstein, Löwenstein, Germany. Electronic address: thomas.graeter@klinik-loewenstein.de.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Graeter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000175:diagnosis*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D012189:Retrospective Studies