SURGERY FOR NONSMALL CELL LUNG-CANCER WITH UNSUSPECTED METASTASIS TO IPSILATERAL MEDIASTINAL OR SUBCARINAL NODES (N2 DISEASE)

Objective. Although the results after surgery for N2 disease are disap pointing, there seems to be a subgroup of patients which may benefit f rom primary resection, These patients have clinically unrecognized N2 involvement that is discovered only at the time of thoracotomy (unsusp ected or unforeseen N2 disease), It was the aim of this retrospective study to analyze the survival after resection for unforeseen N2 diseas e and to evaluate different prognostic factors. We were interested to see whether our strategy of rigorous staging of the mediastinum with m ediastinoscopy or anterior mediastinotomy had an effect on the resecta bility rate and survival of unsuspected N2 disease. Methods. Between 1 985 and 1990, 859 patients with potentially operable non-small cell lu ng cancer were referred to our surgical department. Despite rigorous p reoperative staging with computed tomography scan and cervical mediast inoscopy and/or anterior mediastinotomy, 103 patients (14.5%) had unsu spected N2 disease at thoracotomy, The tumor could be completely resec ted in 90 patients (87.5%). Results. The 5-year survival after complet e resection was 22%. Histology of the tumor, number of involved levels and extent of nodal disease had no effect on survival. Conclusion. We conclude that resection is justified in patients with unforeseen N2 d isease. Rigorous staging of the mediastinum by cervical mediastinoscop y or anterior mediastinotomy results in a high resectability rate and avoids unnecessary thoracotomies, Mediastinoscopy plays a central role in the staging of patients with carcinoma of the lung.