SURGERY FOR LUNG-CANCER WITH MEDIASTINAL LYMPH-NODE INVASION

Or the 3000 patients analyzed in the prospective bronchial carcinoma f ield study, 1086 were operated between 1984 and 1989. Complete systema tic mediastinal lymphadenectomy was performed in 661 patients to asses s the PTNM stage as exactly as possible, and to improve prognosis. Lym phadenectomy removes all hylarand mediastinal lymph nodes. Although th e operation is technically quite easy on the clearly structured right side, it is more difficult on the left side due to the aortic arch and its branches. The lymph nodes of the upper mediastinum of the left an d right side can be completely dissected by mobilizing the aortic arch with the left subclavian artery. In contrast to what is frequently as sumed, the histological findings indicate that there is no general pat tern of metastatic spread in the lymph nodes. The metastases can leave out varying numbers of lymph nodes craniad as well as caudad. For thi s reason, the lymph nodes have to be completely resected to ensure a r eal R0-resection.