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Eur J Cardiothorac Surg 1998;14:152-155
© 1998 Elsevier Science NL

Long-term survivors with pN2 non-small cell lung cancer after a complete resection with a systematic mediastinal node dissection

Department of Chest Surgery, National Kyushu Cancer Center, Fukuoka, Japan

Received 18 November 1997; received in revised form 16 March 1998; accepted 12 May 1998.

^* Corresponding author. Department of Chest Surgery, National Kyushu Cancer Center, 3-1-1, Notame, Minami-ku, Fukuoka 811–1395, Japan. Tel.: +81 92 541 3231; fax: +81 92 551 4585.

Objective: A substantial number of surgical patients with pN2 disease have survived longer than 5 years without any evidence of recurrence, although the surgical indications for those patients remain controversial. The present study was performed in order to clarify the clinical characteristics of the long-term survivors with pN2 disease. Methods: We retrospectively reviewed the cases of 111 patients with pN2 disease who had undergone a complete resection with a systematic mediastinal lymph node dissection from 1974 through 1991. Results: Of the 111 patients with pN2 disease, 20 survived longer than 5 years after a surgical resection. When both the pre- and post-operative conditions were compared between the long-term survivors and the others, the long-term survivors were characterized by significantly higher proportions of cN0 disease (P=0.031), pT1 disease (P=0.004), skip metastasis without hilar node metastasis (P=0.028), and metastasis of a single mediastinal station (0.044). Of those characteristics, only the likelihood of having cN0 disease could be pre-operatively determined. The survival rate of such a population with cN0-pN2 disease was 34.5% at 5 years and 29.6% at 10 years after a complete resection, respectively. Conclusions: Pathologic N2 patients with some favorable prognostic factors can survive long-term after a complete resection combined with a systematic mediastinal lymph node dissection. At present, due to the lack of any effective adjuvant therapy, a systematic mediastinal node dissection should be routinely performed even in patients with cNO disease.

Key Words: Non-small cell lung cancer • pN2-disease • Long-term survivors • Systematic mediastinal node dissection • cNO-pN2 disease

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