Surgery and combined therapy for non-small cell lung cancer with invasion of the mediastinal nodes. A retrospective study

OBJECTIVE: To analyze the survival of patients classified N2M0 (N2 cytology /histology) with non-small cell lung cancer treated by surgical resection o f the primary tumor, lymphadenectomy and neo-adjuvant therapy. PATIENTS AND METHODS: Among 1,043 consecutive patients with lung cancer tre ated between 1990 and 2000, 155 were classified N2MO by histology. Of 130 p atients undergoing thoracotomy, excision of the primary pulmonary tumor and lymphadenectomy were performed in 116. Among the 116 N2MO patients undergo ing surgical resection, 23 were diagnosed N2c((c3)) by mediastinoscopy and/ or mediastinotomy and received induction chemotherapy (CT) with mitomycin/i fosfamide/cisplatin (3 cycles) and 93 were diagnosed N2pM0 after examinatio n of samples of mediastinal lymph tissue taken during thoracotomy; for 19 o f these patients, earlier surgical exploration of the mediastinum had been negative. The patient diagnosed N2p after thoracotomy also received CT and/ or radiotherapy (RT). N2p patients who received induction CT also received RT. Those who were negative after lymphadenectomy and severely ill patients received no adjuvant therapy of any type. RESULTS: Mean survival of resected patients (23/49) diagnosed N2((C3)) by m ediastinoscopy/mediastinotomy and who received induction CT was 18 months. Survival at 1, 2 and 5 years was 80%, 45% and 30%, respectively. No postope rative deaths occurred in this group. One patient developed a bronchopleura l fistula. Nine patients showed no signs of residual mediastinal node disea se after lymphadenectomy. The mean survival of resected patients (93/106) d iagnosed N2p after thoracotomy was 13 months and survival rates at 1, 2 and 5 years were 56%, 31% and 19%, respectively. Fourteen patients in this gro up died within 30 days of surgery. Nine patient developed bronchopleural fi stulas. The difference in survival between the two groups was not significa nt. CONCLUSIONS: Histologic or cytologic confirmation of N2 disease can be cons idered to indicate poor prognosis. Standard, complete surgery with inductio n CT in selected patients improves survival for those diagnosed N2 upon tho racotomy, with no statistically significant differences.