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Vol.43 No.2 contents

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- Original Article -

Problem of a Mediastinal Lymph Node Dissection for the Left Lung Cancer -Significance of the Bilateral Mediastinal Lymph Node Dissection Considering the Last Mediastinal Lymph Nodes-

Makoto Yano¹, Nobuo Ogawa², Naoki Ishiwa², Hideyuki Ito³, Hideto Okuwaki³, Takatomo Morita³, Tatsuo Sato^4
1Department of Thoracic Surgery, Musashino Red Cross Hospital, Japan, ²Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Japan, ³Department of Thoracic Surgery, International Medical Center of Japan, Japan, ⁴Department of Functional Anatomy, Tokyo Medical and Dental University, Japan

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Objective. We examined the outcome of patients with surgical treatment for pN2 left non-small cell lung cancer in relation to the difference of methods of mediastinal lymph node dissection. Methods. The pN2 non-small cell lung cancer patients who had undergone curative pulmonary resection were analyzed separately in two groups, high level N2 group: patients with metastasis to the last mediastinal lymph nodes (superior mediastinal, paratracheal, pretracheal, paraaortic lymph nodes) and low level N2 group: patients without metastasis to the last mediastinal lymph nodes. In each group, the outcome was compared among three subgroups: bilateral group in which a bilateral mediastinal lymph node dissection was performed through a median sternotomy for left lung cancer, standard group in which a standard mediastinal lymph node dissection was performed through a lateral thoracotomy for left lung cancer, right group in which a standard lymph node dissection was performed for right lung cancer. Result. There was no difference in survival among the three subgroups in the high level N2 group. In the low level N2 group, the 5-year survival rate of 17.6% for the standard group was significantly lower than that of 60.0% for the bilateral group and that of 55.0% for the right group. Conclusion. The outcome of the standard group was poor in the low level N2 group, but the standard group might have included several high level N2 group or N3 cases because lymph node dissection around the trachea was incomplete. Further examination is necessary to confirm the significance of a bilateral mediastinal lymph node dissection in the treatment of left lung cancer.
key words: Lung cancer, Mediastinal lymph node dissection

Received: December 3, 2002
Accepted: February 10, 2003

JJLC 43 (2): 121-124, 2003