Skip metastasis and hidden N2 disease in lung cancer: How successful is mediastinal dissection?
- 29 Downloads
Out of 703 consecutive patients who underwent lung cancer surgery from 1986 to 1994, 562 were studied with an emphasis on lymph node metastasis. Skip metastasis was defined as metastasis to the upper mediastinum without involvement of the carinal, hilar, or intrapulmonary nodes. Twenty-nine patients had skip metastasis, accounting for 17% of the 175 with N2 disease. Except for one patient with a huge tumor, there was no lower-lobe disease. Patients with N2 disease nodes were categorized into the following groups: (1) 32 with false negative N2 that could not be detected macroscopically on the specimen; (2) 64 with true positive N2, detected macroscopically on the specimen; and (3) 79 patients with obvious N2. Positive carinal nodes were found in 12 of 70 N2 patients who underwent upper lobectomy, and in 60 of the (105) remaining N2 patients who had other types of surgery. We conclude that upper mediastinal disection should be carried out in patients with adenocarcinoma in the upper lobe, because skip and undetectable metastasis are not rare. However, dissection of the carinal nodes with upper-lobe tumors, and of the upper mediastinum with lower-lobe tumors, can be omitted when the gross and frozen section findings are negative in the upper mediastinum and both the carinal and hilar nodes.
Key Wordslung cancer skip metastasis mediastinal dissection lymph node metastasis
Unable to display preview. Download preview PDF.
- 1.Naruke T, Goya T, Tuchiya R, Suemasu K (1988) The importance of surgery to non-small cell carcinoma of lung with mediastinal lymph node metastasis. Ann Thorac Surg 46:603–610Google Scholar
- 2.Nohl HC (1962) The spread of carcinoma of the bronchus. Lloyd Luke, London, part 1Google Scholar
- 3.Libshitz HI, McKenna RJ, Mountain CF (1986) Patterns of mediastinal metastases in bronchogenic carcinoma. Chest 90:229–232Google Scholar
- 4.Ramsey HE, Cahan WC, Beattie EJ, Humphrey C (1969) The importance of radical lobectomy in lung cancer. J Thorac Cardiovasc Surg 58:225–230Google Scholar
- 5.Martini N, Flehinger BE, Zaman MB, Beattie EJ (1983) Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases. Ann Surg 198:386–397Google Scholar
- 6.Pearson FG, Delarue NC, Ilves R, Todd TRJ, Cooper JD (1982) Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J Thorac Cardiovasc Surg 83:1–11Google Scholar
- 7.Kayaer K, Bach S, Bulzebruck H, Mooykopf IV, Probst G (1990) Site, size and tumor involvement of resected extrapulmonary lymph nodes in lung cancer. J Surg Oncol 43:45–49Google Scholar