LIMITS OF SURGERY IN PATIENTS WITH APPARE NTLY LOCALIZED NONSMALL CELL LUNG-CANCER (PT1-3, PNO, MO)

Despite an apparently curative resection, about 30-40% of the patients with pT1-3, pN0, MO non-small cell carcinomas (NSCLC) will relapse af ter surgery. Therefore, it has to be assumed that in some patients a t umor cell dissemination has occurred already at the time of surgery. B y using sensitive immunocytochemical techniques, the extent of an earl y regional and/or systemic tumor cell dissemination can be demonstrate d. In pN0 patients, an early lymphatic dissemination can be detected i n 15.2% of the cases and a systemic spread of tumor cells into the bon e marrow in 54.3%. Since systematic mediastinal lymphadenectomy does n ot significantly improve the long-term prognosis in these patients, a systemic adjuvant therapy should be offered to patients at risk with a stage I NSCLC.