Lymph node dissection during surgery for lung cancer. Solely staging or therapy?

The accuracy of staging of lung cancer is reflected by the extent of medias tinal lymph node sampling. The more extensively a patient is tested, the mo re likely there will be the accurate N-stage diagnosed. Adequate lymph node dissection during surgery for lung cancer therefore requires complete diss ection of all three ipsilateral mediastinal compartments including the infr acarinal region. Additional contralateral mediastinal lymph node exploratio n may not be justified. A direct therapeutic effect of mediastinal lymph no de removal may be attributed to the prevention of local tumor growth. Howev er, its overall prognostic significance remains unclear because it must be assumed that proven tumor within the mediastinal lymph nodes reflects the s tate of tumor generalization that may not be cured by localized therapeutic means. New systemic interventions are clearly warranted to significantly i mprove prognosis in stage II and III lung cancer patients.