AXILLARY LYMPH-NODE METASTASES FROM BRONCHOGENIC-CARCINOMA

Background. Axillary lymph node metastases (ALNMs) from bronchogenic c arcinoma are rare and their significance may be questioned. A surgical approach may allow a better understanding of the mechanism of their o ccurrence. Methods. A retrospective study of 1,486 cases of surgically removed non-small cell lung carcinoma was performed. Twenty-two patie nts (1.5%) had extrathoracic nodal metastases. Nine of them were ALNMs (< 1%). These cases form the basis of this study. Results. In 1 patie nt ipsilateral ALNM was removed during a lung operation. It was a left non-small cell lung carcinoma invading the chest wall (T3 N2). In the other patients (n = 8) ALNMs were observed during postoperative follo w-up; 4 underwent ALNM resection, 2 had radiotherapy, and 2 had sympto matic treatment only. For these 8 patients, in the TNM classification performed after an initial bronchogenic carcinoma operation, the lymph node status was, respectively, N0 in four cases, NI in three cases, a nd N2 in one case. Survival ranged from 1 to 10 months, except for one patient who is still alive after more than 5 years. In this case, the ALNM was discovered 4 months after a right lower lobectomy for a T2 N 0 adenocarcinoma. Conclusions. Axillary lymph node metastases may be i nvolved through direct chest wall invasion of bronchogenic carcinoma o r retrograde spread from supraclavicular lymphnode block. However, ano ther mechanism seems to be the systemic vascular route. (Ann Thorac Su rg 1998;66:920-2) (C) 1998 by The Society of Thoracic Surgeons.