[Principles and results of systematic lymph node dissection in surgically treated bronchial carcinoma]

Lymphatic spread of bronchial carcinoma can reach any part of the mediastinum, irrespective of the localisation of the primary tumor. Metastatic spread may not affect all topographical lymph node positions, but this is unpredictable. The number of lymph nodes in each position varies. Therefore, systematic mediastinal lymph node dissection includes all ipsilateral compartments of the mediastinum. It is also possible to reach contralateral sites. In right-sided thoracotomies the lymph node dissection is standardized. Mobilizing the aortic arch and the large vessels also allows complete mediastinal dissection by a left-sided approach. The surgical technique is described. Perioperative morbidity does not increase. Systematic mediastinal lymph node dissection is the gold standard for evaluation of an exact pN stage. The stage-related survival rate is significantly improved. Therefore, it should be required that systematic mediastinal lymph node dissection be standard in the surgical treatment of bronchial carcinoma.