[Should lymph node extension be handled by curage or sampling?]

Between 10 and 20% of patients exhibiting normal mediastinum during surgery will present, on histology, invaded lymph nodes when complete curage is performed and, in 25% of cases the mediastinal lymph nodes may be invaded without involvement of the with the hilar lymph nodes. Moreover, such involvement of the mediastinum not uncommon in peripheral tumours. Hence it is clear that multiple mediastinal node samples should be taken. Should simple "sampling" be performed as is recommended by the Lung Cancer Study Group or lymph node curage? The morbidity inherent to curage and the fact that, despite several randomised studies, the impact of curage on survival has not been clearly demonstrated, explains the continued debate.