[Rationale of thoracic lymph node dissection in pulmonary metastasectomy]

The goal of metastasectomy is a R0 resection. Depending of the tumor entity the prevalence of lymph node metastases in pulmonary metastasectomy can be up to 45%; however, systematic lymph node dissection is not yet established as a fixed component of metastasectomy. Although there is a high prevalence of lymph node metastases and the increase in the prevalence with a higher number of lung metastases, it remains unclear if a systematic lymph node dissection should be part of pulmonary metastasectomy. For this reason, the goal of this review was to evaluate the rationale of systematic lymph node dissection in pulmonary metastasectomy based on the currently available literature. Furthermore, it was investigated whether patients with additional thoracic lymph node metastases should be excluded per se from pulmonary metastasectomy, even though positive lymph node metastases might be associated with a lower but nevertheless good long-term survival after resection.