非小細胞肺癌縦隔リンパ節転移の実態と予後からみた縦隔郭清の意義

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  • MEDIASTINAL LYMPH NODE DISSECTION FOR NON-SMALL CELL LUNG CARCINOMA

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The authors analyzed the accuracy of preoperastive detection of mediastinal lymph node metastasis with computed tomography and correlated the levels of mediastinal lymph node metastases with the location of primary tumors, the CT factor, and the results of surgical treatment for non-small cell lung carcinoma. During the past 21 years 228 squamous cell carcinomas and 217 adenocarcinomas were removed by lobectomy or pneumonectomy, and all accessible mediastinal lymph nodes were resected. The preoperative diagnosis of mediastinal lymph node metastases from computed tomography findings was accurate in only 55% of squamous cell carcinomas and 43% of adenocarcinomas. Right upper lobe carcinomas were apt to metastasize to #1-4 lymph nodes and middle or lower lobe carcinomas to #7 nodes. Carcinomas of both left lobe were apt to metastasize to #5 or 6 lymph nodes. Of the pN2 squamous cell carcinomas 7.2% and of the adenocarcinomas 34.5% were cT1. Thus, the cT factor in pN2 adenocar-cinomas was significantly smaller than that in squamous cell carcinomas with mediastinal lymph node metastases. The survival rates of patients with pNO or pN1 cancers were significantly better than those with pN2 or pN3 cancers. However, the 5-year cumulative survival rate of patients with pN2 cancers treated with relative curative resection was over 20%, being significantly better than that of patients who were treated with non-curative resection.<br> We conclude that mediastinal lymph node dissection which aims at curative surgery should be performed for all resectable non-small cell bronchogenic carcinomas regardless of the preoperative diagnosis of mediastinal lymph node metastasis, the location of the primary tumor, or the histological type, since the preoperative diagnosis of mediastinal lymph node metastasis is not very reliable and many small cancers, especially adenocarcinomas, have mediastinal metastases.

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