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Point and Counterpoint |

COUNTERPOINT: Is N2 Disease a Contraindication for Surgical Resection for Superior Sulcus Tumors? NoN2 Disease and Sulcus Tumors? No

Wilson W. Li, MD; Jacobus A. Burgers, MD, PhD; Houke M. Klomp, MD, PhD; Koen J. Hartemink, MD, PhD
Author and Funding Information

From the Department of Cardiothoracic Surgery (Dr Li), Academic Medical Center, University of Amsterdam; and Department of Thoracic Oncology (Dr Burgers) and Department of Thoracic Surgery (Drs Klomp and Hartemink), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital.

CORRESPONDENCE TO: Wilson W. Li, MD, Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; e-mail: w.w.li@amc.uva.nl


CONFLICT OF INTEREST: None declared.

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


Chest. 2015;148(6):1375-1379. doi:10.1378/chest.15-1196
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For patients with superior sulcus tumors (SSTs) (ie, lung cancer invading the apical chest wall structures), trimodality therapy has become the mainstay of treatment as recommended by the 2013 American College of Chest Physicians (CHEST) lung cancer guidelines.1 The guidelines also state that involvement of mediastinal lymph nodes (N2 disease) is associated with poor survival after resection, contraindicating surgical treatment.1 However, the association of N2 disease with poor survival is based on results derived mainly from the era before the advent of trimodality therapy. Furthermore, this focus on survival bypasses potential palliative indications for resections of SSTs, which can induce severe, disabling pain symptoms. Pain control may be improved by additional surgical resection.2,3 Because the treatment of pain in these patients is a major priority,4 a well-balanced surgical approach should still be considered,3,5 even in the presence of potential negative prognostic factors for survival, such as N2 disease.

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