The role of surgery in patients with clinical n2 disease

Patients with N2 non-small cell lung carcinoma have ipsilateral mediastinal adenopathy with stage IIIA disease. Most of these patients are still staged solely using imaging techniques, which causes a significant error in staging if not combined with some form of surgical staging of the mediastinum. N2 disease forms a spectrum of disease ranging from occult microscopic disease to bulky multistation adenopathy. Proper understanding of the prognosis and treatment implications for each form of mediastinal lymph node metastases has led to the selective use of surgery to treat these patients. This article reviews the role of surgery in the management of patients with N2 mediastinal involvement.