[Results of surgery for non-small cell lung cancer with N2 involvement unsuspected before thoracotomy]

To analyze survival in a group of patients with N2 involvement discovered during or after lung resection for non-small cell lung cancer and to evaluate the variables that affect survival.

The study included all patients with non-small cell lung cancer who underwent resection between January 1994 and October 2004 and in whom the definitive tumor classification was stage spIIIA due to N2 extension (n=74). Patients with stage spIIIB undergoing induction chemotherapy and patients for whom surgery was considered incomplete were excluded.

Mean survival times were significantly different (P=.002) between resection types: pneumonectomy, 18.1 months (95% confidence interval [CI], 6.9-29.2 months), and lobectomy, 42.4 months (95% CI, 28.7-56.1 months). The number of lymph-node stations affected did not have a significant effect on survival. However, when only 1 station was involved, mean survival was different for lobectomy and pneumonectomy (48.0 months [95% CI, 31-65 months] vs 14.8 months [95% CI, 4.8-24.7 months], respectively; P=.002) but no differences were found when N2 spread involved more than a single station. Adjuvant therapy was used in 50% of cases (n=35): chemotherapy in 6 cases; radiotherapy in 17 cases; and both in 12 cases. The mean survival rate for lobectomy patients with no adjuvant therapy was 31.6 months (95% CI, 15.6-47.5 months) and 46.2 months (95% CI, 32.2-60.1 months) (P=.01) with adjuvant therapy, whereas there were no differences in the group of pneumonectomy patients.

Patients who undergo lobectomy clearly survive longer than those who undergo pneumonectomy when N2 lymph node involvement is found in only 1 station during surgery. Furthermore, adjuvant therapy may increase mean survival times for lobectomy patients.