N2 Disease

Metastases to mediastinal lymph nodes is noted in nearly half of patients with nonsmall cell lung carcinoma. Although pessimism prevails about the outcome of treatment of N-2 disease, a select group of patients with mediastinal node disease may benefit from resection. In a right-sided thoracotomy and pulmonary resection, fairly complete dissection of ipsilateral, mediastinal and subcarinal lymph nodes is possible. This is much more difficult in tumors involving the left lung. On the right side, the superior mediastinum and subcarinal region and inferior mediastinum are accessible. On the left side, the subarotic region is accessible, but the superior mediastinum is very difficult to get access to. The subcarinal region and inferior mediastinum can be approached from the left side, however. The prognostics and significance of positive mediastinal nodes differs if the mediastinal involvement with carcinoma is determined at the time of the mediastinoscopy or if it is determined at the time of thoracotomy. If the N-2 disease is discovered at mediastinoscopy and a pulmonary resection done, only about 10% survive 5 years. On the other hand, if the N-2 disease is previously unsuspected but is discovered at thoracotomy, approximately one-third survive 5 years. The implication is that patients found to have micrometastases to mediastinal nodes at the time of lung resection may have a good chance for survival if adequate mediastinal dissection and extirpation of tumor is performed.

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