Mediastinal lymph node infiltration in non-small cell lung cancer and its role in curative surgery

Despite the importance of lymph node infiltration for the classification an d prognosis of non-small cell lung cancer (NSCLC), there are no accepted st andards for quality of mediastinal lymphadenectomy. In 270 consecutive pati ents undergoing potentially curative surgery for NSCLC, including complete ipsilateral lymph node dissection, we investigated the possibility of a cor relation between tumour location and lymph node infiltration. The tumours w ere classified as UICC stage I (n = 115), II (n = 42) or IIIa (n = 113). Pa tients with N2-disease (n = 68) showed up to 81% skip metastasis. Because o f the observed dissemination of lymph node metastasis, tumour location coul d not predict nodal infiltration. The variability of nodal involvement and the frequent occurrence of skip metastasis thus make complete ipsilateral l ymphadenectomy mandatory for curative management of NSCLC.