Results of resection for bronchogenic carcinoma with mediastinal lymph node metastases in selected patients

Abstract

Between 1982 and 1988, 254 consecutive patients underwent resection forbronchogenic carcinoma with mediastinal lymph node metastases at MarieLannelongue Hospital. Selection of cases for surgery was carried out usingCT and mediastinoscopy. The surgical procedure performed were pneumonectomy(169), lobectomy (65), or bilobectomy (20) associated with resection ofipsilateral mediastinal lymph nodes. Almost all diseased nodes appearedgrossly enlarged at surgery and only a few were of normal size.Postoperative mortality was 5.6%. Resection was potentially curative in 191cases (75%) and palliative in 63 cases (25%). Almost all patients receivedadjuvant treatment (mainly radiotherapy). Actuarial 5-year survival was 18%for the entire group, and 23% for those who underwent curative resection.No patient with palliative resection survived 5 years. The followingfactors proved to be significantly associated with a better prognosis:complete resection, independent lymph node metastases, involvement of onlyone level, lower paratracheal involvement. On the other hand, there was nodifference between pathological types (squamous cell carcinomas,adenocarcinomas, oat cell carcinomas) with regard to prognosis. We advocatean aggressive approach in selected cases of N2 bronchogenic carcinoma.Neoadjuvant chemotherapy should be tested in these specific patients with aview to the possibility of improving results.