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Eur J Cardiothorac Surg 1999;16:S11-S12
© 1999 Elsevier Science NL

Is radical lymphadenectomy a valid oncologic procedure?

The Cardio-Thoracic Surgical Group, 185 Livingston Avenue, New Brunswick, NJ 08902, USA

The first 20% of the full text of this article appears below.

Surgeons have always been interested in anatomic structures that can be visualized, palpated, dissected and resected. Because lymph nodes have all of these qualitative characteristics, they have attracted the interest of surgeons since the late 19th century. In fact, oncologic significance has been attributed to them and resection has been advocated and even mandated as being an essential component for the treatment of patients with carcinoma. Unfortunately, this theory was predicated more upon intuition than scientific evidence. Nevertheless, as we enter the 21st century, surgeons still remain adamant in believing that lymph node resection can benefit and even cure patients with cancer.

The Barrier Theory, postulated by 19th century surgeons, maintains that lymph flows in a consistent, predictable sequential manner from nodal station to nodal station where malignant cells are impeded or detained. In reality, lymph flows in a haphazard, bizarre, unpredictable manner skipping many nodal stations. Malignant cells pass through lymph nodes as if they were a sieve, and because of infinite lymphaticovenous communications, they can easily enter the vascular system achieving diffuse and distant dissemination.

Radical lymphadenectomy is not an innocuous procedure since it requires a major dissection that interrupts and damages neurogenic, vascular and lymphatic structures in the mediastinum. Neurogenic interruption can cause pulmonary vascular spasm that physiologically reduces vascular volume simulating cor pulmonale and can increase right heart burden. Cardiac output can be decreased and arrythmias incited. A concurrent lobectomy, which anatomically removes a large vascular volume, contributes further to these detrimental occurrences. Bleeding requiring transfusion is not uncommon. Administration of blood can . . . [Full Text of this Article]

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