TREATMENT STRATEGY FOR PATIENTS WITH SURGICALLY DISCOVERED N2 STAGE IIIA NONSMALL CELL LUNG-CANCER

Background. The treatment strategy for patients with non-small cell lu ng cancer and clinically negative, but surgically detected mediastinal lymph node metastasis (surgically discovered N2 disease) is controver sial. Methods. From August 1979 through December 1994, 53 patients wit h non-small cell lung cancer were found to have surgically discovered N2 disease. We retrospectively studied the clinical characteristics an d the factors that influenced the prognosis in these patients. Results . The 3-year and 5-year survival rates and the median survival for the 53 patients with surgically discovered N2 disease were 44%, 21%, and 26 months. Two thirds of the patients had adenocarcinoma. Only complet e resection affected long-term survival; adjuvant therapy had no effec t on survival. In regard to lymph node status, a single metastatic foc us in the aortic area was associated with long-term survival. Conclusi ons. Patients with adenocarcinoma may require histologic determination of N2 disease. Complete resection, including extensive and complete m ediastinal lymph node dissection, is warranted in patients with surgic ally discovered N2 disease. In particular, when the aortic lymph node (including stations 5 and 6) alone is involved, the patients should un dergo as complete a resection as possible. (C) 1997 by The Society of Thoracic Surgeons.