RESULTS OF SURGICAL RESECTION OF STAGE-IIIA (N2) NON-SMALL-CELL LUNG-CANCER, ACCORDING TO THE SITE OF THE MEDIASTINAL METASTASES

Out of a series of 1563 consecutive patients submitted to thoracotomy for lung cancer between 1980 and 1990, 278 patients underwent a resect ion for a non small cell lung cancer (NSCLC) with mediastinal node met astases (N2). Selection of cases for surgery was carried out using CT from 1983 and mediastinoscopy for the patients with mediastinal lymph nodes larger than 1.5 cm from 1985: all patients with positive mediast inoscopy were excluded from thoracotomy, but 10 cases underwent a rese ction after neoadjuvant radio-chemotherapy. The surgical procedures we re pneumonectomy (106), lobectomy (146) and atypical resection (8) wit h ipsilateral mediastinal lymphadenectomy. Resection was complete in 2 36 patients (84.8%) and incomplete in 42 patients (15.2%). Postoperati ve mortality was 3.2%. Almost all patients received radiotherapy after surgery. Actuarial 5-year survival was 13.7% for the entire group and 18.5% for the patients who underwent curative resection; no patients survived 5 years after palliative resection (p < 0.05). There were no differences with regard to prognosis according to the histology of the tumors and to surgical procedures. A better prognosis is associated w ith: completeness of resection, involvement of only one level, low T c lassification. Five-year survival rate of patients with metastases onl y in upper mediastinum was 25%; on the contrary 5-year survival rate o f patients with metastases in the lymph nodes of the lower mediastinum was only 8% (p < 0.05). In our opinion better results among the patie nts with metastases in the upper mediastinum depends on the selection obtained with mediastinoscopy. We now need to improve selection of pat ients with subcarinal metastases; we hope that video-thoracoscopy will obtain biopsies of enlarged subcarinal nodes.