Treatment of Bronchogenic Carcinoma with Mediastinal Metastases

doi:10.1016/S0003-4975(10)65088-6

The Annals of Thoracic Surgery

Volume 12, Issue 1, July 1971, Pages 11-21

https://doi.org/10.1016/S0003-4975(10)65088-6 Get rights and content

Abstract

Mediastinal lymph node dissection in conjunction with pulmonary resection was performed on 231 patients with bronchogenic carcinoma. Mediastinal metastases were found in 48 patients. Thirty-six of these 48 patients underwent mediastinal irradiation in the immediate postoperative period.

Seven of the 36 patients receiving postoperative irradiation lived five years (an absolute five-year survival rate of 19.5%). Of 17 patients with squamous cell carcinoma and mediastinal metastases, 5 lived five years (a five-year survival rate of 29.5%); only 1 of the 17 patients with adenocarcinoma and mediastinal metastases lived five years (an absolute survival rate of 5.9%). No patient who did not receive mediastinal irradiation postoperatively survived five years.

The presence of mediastinal lymph node involvement in patients with squamous cell carcinoma of the lung is not a contraindication to resection because long-term survival can be achieved in a significant percentage of these patients.

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Cited by (53)

Long-term survival of patients with pN2 lung cancer according to the pattern of lymphatic spread
2014, Annals of Thoracic Surgery
Citation Excerpt :
We observed that pN0N2, also known as skip-pN2, represented 30% of pN2 patients. The so-called “skip phenomenon” has been described in the clinical setting [2, 3, 20] and objectively documented by anatomic study [21] more than 20 years ago. A direct connection of the pulmonary lymph drainage to the mediastinal LN with no intrapulmonary or hilar relay is observed in approximately 25% of anatomic cases.
N2 involvement has dramatic consequences on the prognosis and management of patients with non-small cell lung cancer (NSCLC). N2-NSCLC may present with or without N1 involvement, constituting non-skip (pN1N2) and skip (pN0N2) diseases, respectively. As the prognostic impact of this subclassification is still a matter of debate, we analyzed the prognosis of pN2 patients according to the pN1-involvement and the number of N2-stations concerned.
The medical records of consecutive patients who underwent surgery for pN2-NSCLC in 2 French centers between 1980 and 2009 were prospectively collected and retrospectively reviewed. Patients undergoing induction therapy, exploratory thoracotomy, incomplete mediastinal lymphadenectomy, or incomplete resections were excluded. The prognoses of pN1N2 and pN0N2 patients were first compared, and then deciphered according to the number of N2 stations involved (single-station: 1S, multi-station: 2S).
All together, 871 patients underwent first-line complete surgical resection for pN2-NSCLC during the study period, including 258 pN0N2 (29.6%) and 613 pN1N2 (70.4%) patients. Mean follow-up was 72.8 ± 48 months. Median, 5- and 10-year survivals were, respectively, 30 months, 34%, and 24% for pN0N2 and 20 months, 21%, and 14% for pN1N2 patients (p < 0.001). Multivariate analysis revealed 3 different prognostic groups; ie, favorable in pN0N2-1S disease, intermediate in pN0N2-2S and pN1N2-1S diseases, and poor in pN1N2-2S disease (p < 0.001).
Among pN2 patients, the combination of N1 involvement (pN0N2 vs pN1N2) and number of involved N2 stations (1S vs 2S) are independent prognostic factors. These results might be taken into consideration to sub-classify the heterogeneous pN2-NSCLC group of patients.
Skip mediastinal lymph node metastasis and lung cancer: A particular N2 subgroup with a better prognosis
2005, Annals of Thoracic Surgery
Lymph node (LN) metastases from lung cancer may skip the intrapulmonary nodes directly to the mediastinum ([N1−]N2 vs [N1+]N2). This phenomenon is frequent. Patients with such a metastatic pattern appear to have a better prognosis following surgery. Our purpose was to further study the clinical significance and prognostic value of this particular group of (N1−)N2 patients.
We retrospectively analyzed the data of 731 patients with a pN2 stage who underwent resection for non-small cell lung cancer. Patients with (N1−)N2 metastases (n = 209) were compared to patients with intrapulmonary (N1+)N2 (n = 522).
In the (N1−)N2 group, lobectomies were more frequent (54% vs 33%, p = 0.00), metastases more frequently involved a single LN station (79.4% vs 56.3%, p < 0.000001), and primary tumor was more often located in the upper lobes (67.4% vs 55.6%, p = 0.0066). (N1−)N2 was a factor of better prognosis (5 year survival rates 34.4% vs 18.5%, p = 0.00006), which proved also significant when only a single station was involved (38.4% vs 24%, p = 0.0005). These results were confirmed by multivariate analysis.
(N1−)N2 skip metastasis is a unique subgroup of pN2 disease. Lung lymph drainage anatomy may explain the occurrence of these metastases. They form an independent prognostic factor of survival suggesting the need for further study, the results of which may lead to better knowledge of lung cancer, improved classification, and adapted adjuvant therapy.
What were the issues of surgical importance in lung cancer treatment in 1977; and how did they change over time?
1994, Chest
The LCSG tested innovative and standard adjuvant treatments aimed at strengthening the effectiveness of surgical resection. The group addressed issues related to standardizing and improving surgical treatment, and the perioperative use of chemotherapy, radiotherapy, and immunotherapy alone and in combination. The surgical leadership, meticulous methodology, and interdisciplinary cooperation mobilized to address these issues made the group the reference standard for thoracic oncology trials.
Mediastinoscopy 1992: is it still essential?
1992, Lung Cancer
Pretreatment minimal staging
1991, Lung Cancer
Surgical treatment of lung cancer
1991, Chest

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: Presented at the Seventh Annual Meeting of The Society of Thoracic Surgeons. Dallas. Tex., Jan. 18-20, 1971.

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The Annals of Thoracic Surgery

Abstract

References (25)

A follow-up in patients with bronchogenic carcinoma “locally cured” by preoperative irradiation

J. Thorac. Cardiovasc. Surg.

Combined radiotherapy and resection for carcinoma of the bronchus'. Experiences with 66 patients

Lancet

Radical pneumonectomy

J. Thorac. Surg.

Further studies in the surgical management of carcinoma of the lung: A further study of the cases treated at the Massachusetts General Hospital from 1950 to 1957

J. Thorac. Surg.

The surgical treatment of pulmonary neoplasms: A 10-year experience

J. Thorac. Cardiovasc. Surg.

Carcinoma of the lung

Curr. Probl. Surg.

The importance of radical lobectomy in lung cancer

J. Thorac. Cardiovasc. Surg.

Cervical mediastinal lymph node exploration for diagnosis and determination of operability

Ann. Thorac. Surg.

Pneumonectomy and lobectomy in bronchogenic carcinoma: A comparison of and results of the Overholt and Ochsner clinics

J. Thorac. Cardiovasc. Surg.

The clinical management of bronchogenic carcinoma

Johns Hopkins Med. J.

De waarde van postoperatieve roentgen-bestraling bij bronchuscarcinoom

Nederl. T. Geneesk.

Surgical treatment of carcinoma of the bronchus

Brit. Med. J.

Cited by (53)

Long-term survival of patients with pN2 lung cancer according to the pattern of lymphatic spread

Skip mediastinal lymph node metastasis and lung cancer: A particular N2 subgroup with a better prognosis

What were the issues of surgical importance in lung cancer treatment in 1977; and how did they change over time?

Mediastinoscopy 1992: is it still essential?

Pretreatment minimal staging

Surgical treatment of lung cancer