PRINCIPLES AND RESULTS OF SYSTEMATIC LYMP H-NODE DISSECTION IN RESECTED BRONCHIAL-CARCINOMA

Lymphatic spread of bronchial carcinoma can reach any part of the medi astinum, irrespective of the localisation of the primary tumor. Metast atic spread may not affect al topographical lymph node positions, but this is unpredictable. The number of lymph nodes in each position vari es. Therefore, systematic mediastinal lymph node dissection includes a ll ipsilateral compartments of the mediastinum. It is also possible to reach contralateral sites. In right-sided thoracotomies the lymph nod e dissection is standardized. Mobilizing the aortic arch and the large vessels also allows complete mediastinal dissection by a left-sided a pproach. 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 requi red that systematic mediastinal lymph node dissection be standard in t he surgical treatment of bronchial carcinoma.