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Original Research: Lung Cancer |

Lobe-Specific Mediastinal Nodal Dissection Is Sufficient During Lobectomy by Video-Assisted Thoracic Surgery or Thoracotomy for Early-Stage Lung CancerLobe-specific N2 Nodal Dissection in Early Cancer

Mark Shapiro, MD; Sagar Kadakia, MD; James Lim, MD; Andrew Breglio, BA; Juan P. Wisnivesky, MD, DrPH; Andrew Kaufman, MD; Dong-Seok Lee, MD; Raja M. Flores, MD
Author and Funding Information

From the Division of Thoracic Surgery (Drs Shapiro, Kadakia, Lim, Kaufman, Lee, and Flores and Mr Breglio) and the Division of Pulmonary and Critical Care Medicine (Dr Wisnivesky), Mount Sinai Medical Center, New York, NY.

Correspondence to: Raja M. Flores, MD, Division of Thoracic Surgery, Mount Sinai Medical Center, 1190 Fifth Ave, Box 1028, New York, NY 10029; e-mail: raja.flores@mountsinai.org


This manuscript was presented as a podium presentation at the CHEST 2012 meeting, October 20-25, 2012, Atlanta, GA.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(5):1615-1621. doi:10.1378/chest.12-3069
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Background:  Lobectomy with complete mediastinal lymphadenectomy is considered standard for patients with early-stage non-small cell lung cancer (NSCLC). However, the benefits of complete lymphadenectomy are unproven. There is evidence suggesting a predictable pattern of mediastinal nodal drainage. This study analyzed the frequency and pattern of mediastinal nodal disease and its impact on outcome in patients with early-stage NSCLC.

Methods:  Patients with clinical N0/N1 NSCLC staged with CT scans and PET scans were identified. Disease involvement of resected nodal stations was recorded. Patterns of recurrence in patients who underwent lobectomy with complete mediastinal systematic lymph node sampling (SLNS) were compared with those who underwent lobe-specific mediastinal SLNS.

Results:  From July 2004 to April 2011, 370 patients were identified. Complete SLNS was performed in 282 patients. Fifteen patients (5.3%) in the group with complete SLNS were found to have N2 disease after pathologic evaluation. Patients with left-sided tumors were more likely to have pathologic N2 disease than were patients with right-sided tumors (P = .03). Only one patient (0.36%) had positive N2 disease in the distal mediastinum while skipping lobe-specific mediastinal nodes. In addition, patients with complete SLNS had a rate of recurrence similar to that of the group that had lobe-specific mediastinal evaluation (20.6% vs 18.2%, P = .68).

Conclusions:  Mediastinal N2 metastases follow predictable lobe-specific patterns in patients with negative preoperative CT scans and PET scans. Lobe-specific N2 nodal evaluation results in a recurrence rate similar to that of complete mediastinal evaluation. Lobe-specific mediastinal nodal evaluation appears acceptable in patients with early-stage NSCLC.

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