Operative results of non-small cell lung cancer clinically presenting mediastinal lymph adenopathy

Selection of treatment for operable N2 non-small cell lung cancer (NSCLC) is still controversial. If considered resectable, we have actively performed surgery even for clinical stage IIIA-N2 disease. In this retrospective study, surgical results in NSCLC with clinically presenting mediastinal lymph adenopathy examined to investigate its indication.

Consecutive 202 patients who were preoperatively diagnosed or suspected of mediastinal lymph adenopathy and underwent operation were investigated for such as pathological judgement of nodal metastasis, completeness of operation and prognosis. Perioperative chemotherapy and/or radiotherapy was performed in 56 patients.

Pathological diagnosis of nodal status was N0 in 64 patients, N1 in 27, N2 in 104 and N3 in 7. Complete resection was performed in 109 patients (54%). In 111 patients with pathologically proven N2 (pN2), only 40 (36%) were completely resected. The reason of incomplete resection included extranodal extension of mediastinal nodal metastasis in 31 patients, pleural dissemination in 18, extension of primary tumor to mediastinum in 11. Median post-operative survival time was 553 days, and survival rates at 2- and 5-years were 43% and 22%, respectively. In all pN2, survival rates at 2- and 5-years were 33% and 11%, respectively. In 40 patients of completely resected pN2, survival rates at 2- and 5-years were 42% and 22%, respectively, whereas those were 17% and 5% in 64 patients with incompletely resected pN2. The positive effect of perioperative treatment on survival was not apparent.

If resectable, surgical approach to N2 might be approved, however, extensive examination is required prior to therapy to avoid incomplete resection.