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Ann Thorac Surg 1990;50:708-713
© 1990 The Society of Thoracic Surgeons

Articles

Strategy for lymphadenectomy in lung cancer three centimeters or less in diameter

Teruyoshi Ishida, MD*, Tokujiro Yano, MD, Kazunobu Maeda, MD, Satoshi Kaneko, MD, Masahiro Tateishi, MD, Keizo Sugimachi, MD

Department of Surgery II, Faculty of Medicine, Kyushu University, Fukuoka, Japan

Accepted for publication May 22, 1990.

* Address reprint requests to Dr Ishida, Department of Surgery II, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812, Japan.

We have surgically treated 221 patients with a primary lung cancer 3.0 cm or less in diameter. There were 8 patients with a tumor 1.0 cm or less in diameter (group A), 84 with a tumor 1.1 to 2.0 cm in diameter (group B), and 129 with a tumor 2.1 to 3.0 cm in diameter (group C). The incidence of N0, N1, and N2 disease was 100%, 0%, and 0%, respectively, for patients in group A; 83%, 5%, and 12% in group B; and 62%, 12%, and 25% in group C (N0 versus N2, p < 0.01). For the 63 patients with regional lymph node involvement, "skipping" metastasis was present in 28.6%. The 5-year survival rate was 80% for group A, 74% for group B, and 51% for group C (group B versus group C, p < 0.01). Of the 121 patients who underwent complete resection and were followed up for 5 years, 41% had recurrence, 8% with local recurrence and 33% with distant metastasis. Therefore, it is important to do as complete a resection as possible together with mediastinal lymphadenectomy. Efforts to detect systemic spread should be made at the time of preoperative evaluation, even when the lung tumor is small.




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