[Mediastinal lymphadenectomy. Anatomical basis and its surgical relevance in central bronchus carcinoma]

102 patients with potentially curable bronchial carcinoma were subjected to pneumonectomy and mediastinal lymph node dissection regardless of gross appearance of the mediastinum at the time of surgery. 83 of these patients were analysed retrospectively. In 34 patients (41%) enlarged mediastinal lymph nodes were found; in 19 of these (56%) malignant invasion was verified histologically, whereas in 15 of these 34 patients (44%) the enlarged lymph nodes revealed only inflammatory changes. On the other hand, in 49 patients (59%) the mediastinum was grossly inconspicuous, yet in 2 of these patients (4.1%) microscopic invasion by carcinoma was found. This confirms that the assessment of the mediastinum by gross appearance is unreliable. As a consequence, mediastinal lymph node dissection should be performed routinely in all patients in order to detect occult metastases since only patients who had a complete resection have a change of cure. This approach is justified as in our experience mediastinal lymph node dissection does not impose an additional operative risk and long-term survival or even cure may be achieved in individual patients. Estimated 5-year survival in our patients with histologically proven mediastinal lymph node metastases was 22%; 3 of 21 patients with N 2 carcinoma are alive 8, 10 and 13 years p.o., without evidence of recurrence. The operative strategy and technical aspects based on anatomical knowledge of pathways of lymphatic spread of carcinoma of the lung are presented.