Surgical treatment of non-small cell lung cancer with mediastinal node invasion. A retrospective study

OBJECTIVE: To analyze the survival of patients classified as N(2)M0 (N2 by cytohistology) with non-small cell lung cancer treated by surgical resectio n of the primary tumor and lymphadenectomy. PATIENTS AND METHOD: Among 1043 consecutive patients with lung cancer who w ere considered for surgery between 1990 and 2000, 155 were classified N2M0 by histology. Surgical exeresis of the primarily pulmonary tumor and lympha denectomy were performed in 116 patients of the 130 patients who underwent thoracotomy. Among the 116 N2M0 patients undergoing surgical resection, 23 were diagnosed N2c((C3)) by mediastinoscopy and/or mediastinotomy and were given induction chemotherapy (ChT) (mitomycin/ifosfamide/cisplatin, 3 cycle s) and 93 were diagnosed N2pM0 based on samples obtained from mediastinal l ymph tissue during thoracotomy. Nineteen of the latter had previously been classified negative during surgical exploration. The patients diagnosed N2p after thoracotomy were given adjuvant ChT, radiotherapy or both. N2p patie nts who received induction therapy were given radiotherapy. Those found neg ative after lymphadenectomy and patients with severe disease were given no adjuvant treatment. RESULTS: Mean survival was 18 months for resected patients diagnosed N2 by mediastinoscopy/mediastinotomy and with induction ChT and survival at one, two and five years was 80%, 45% and 30%, respectively. No postoperative mor tality was recorded in this group. One patient suffered bronchopleural fist ula. Nine patients showed no residual mediastinal node disease after lympha denectomy. The mean survival of resected patients diagnosed N2p by thoracot omy was 13 months, and one, two and five year survival rates were 56%, 31% and 19%, respectively. Fourteen patients died within 30 days of surgery. Ni ne patients developed a bronchopleural fistula. The difference in survival of the two groups was not significant. CONCLUSIONS: The prognosis after cytohistologic confirmation of N2 disease can be considered poor. Standard, complete surgery plus induction therapy i n screened patients improved survival for those diagnosed N2 by thoracotomy , with no statistically significant differences.