LYMPH-NODE INVOLVEMENT, RECURRENCE, AND PROGNOSIS IN RESECTED SMALL, PERIPHERAL, NON-SMALL-CELL LUNG CARCINOMAS - ARE THESE CARCINOMAS CANDIDATES FOR VIDEO-ASSISTED LOBECTOMY

To determine the clinicopathologic characteristics of peripheral non-s mall-cell carcinomas, the cases of 337 patients undergoing major pulmo nary resection with complete lymphadenectomy were retrospectively revi ewed with regard to lymph node involvement, recurrence, and prognosis. All of the tumors were 3.0 cm or less in diameter and were categorize d as T1 (318 patients) or T2 (19). Eighty-eight patients (26.1%) had l ymph node involvement: 32 (9.5%) at N1 nodes, 55 (16.3%) at N2 nodes, and 1 (0.3%) at N3 nodes. Although the prevalence of lymph node involv ement did not differ significantly with tumor histologic type, it was quite low in squamous cell carcinomas 2.0 cm or less in diameter. Of t he 56 N2/3 metastases, 14 (25%) occurred in a ''skipping'' manner, and ail but one had a nonsquamous histologic makeup. Of the 213 patients with a follow-up period of 5 years or more, 59 patients (27.7%) shelve d cancer recurrence. This occurred at a distant site in 67.8% of the c ases. Five-year survival rates based on nodal status were 91.9% (N0), 61.8% (N1), 44.5% (N2), and 0% (N3). Because of the relatively high pr evalence of lymph node involvement, complete hilar/mediastinal lymphad enectomy should be routinely done regardless of tumor histologic type and size, as long as patients are at good risk. However, in squamous c ell histologic types, mediastinal lymphadenectomy might be dispensable if the tumor is less than 2.0 cm in diameter, or if the hilar node is proved to be tumor-free on pathologic examination of the frozen secti on during operation. Although video-assisted major pulmonary resection currently has limited application, this new technique may represent a surgical option in resection without complete lymphadenectomy.