PROGNOSIS OF UNSUSPECTED BUT COMPLETELY RESECTABLE N2 NONSMALL CELL LUNG-CANCER

Of 111 patients with non-small cell lung cancer without clinically evi dent N2 disease 95 underwent mediastinoscopy between 1975 and 1985. In 63 cases mediastinoscopy was positive and in 32 negative. The patient s with a positive mediastinoscopy were considered to have inoperable d isease. Their 3- and 5-year survival rates were 5% and 0%, respectivel y. The patients with a negative mediastinoscopy and 16 patients in who m no mediastinoscopy was performed because of a peripheral tumor under went operation. They underwent complete tumor resection and mediastina l lymph node dissection. Unsuspected N2 disease was found. Their 3- an d 5-year survival rates were 19% and 10%, respectively. The better sur vival rate in the operated group was statistically significant and mai nly due to a better survival of the lobectomy group. Multiple regressi on analysis showed no favorable prognostic factors in the nonoperated group, but in the operated group lobectomy and central location of the tumor significantly improved the prognosis. We conclude that patients with unsuspected stage IIIa non-small cell lung cancer discovered at thoracotomy benefit from complete tumor resection and mediastinal lymp h node dissection, especially if the resection can be confined to lobe ctomy and if the tumor is located centrally.