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Jeffrey L. Port
Robert J. Korst
Paul C. Lee
Nasser K. Altorki
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Ann Thorac Surg 2005;79:1686-1690
© 2005 The Society of Thoracic Surgeons

Original articles: General thoracic

Surgical Resection for Residual N2 Disease After Induction Chemotherapy

Jeffrey L. Port, MD, Robert J. Korst, MD, Paul C. Lee, MD, Matthew A. Levin, BS, David E. Becker, MA, Roger Keresztes, MD, Nasser K. Altorki, MD*

Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York

Accepted for publication October 26, 2004.

* Address reprint requests to Dr Altorki, Department of Cardiothoracic Surgery, Suite M404, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021 (E-mail: nkaltork{at}med.cornell.edu).

Presented at the Poster Session of the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.

BACKGROUND: Induction therapy is a common treatment modality for patients with stage IIIA non-small cell lung cancer (NSCLC). Although mediastinal nodal downstaging after induction therapy is generally considered a favorable prognostic feature, the benefit of resection in the presence of residual N2 disease is controversial. In this study we analyzed our experience with resection after induction chemotherapy in patients with residual N2 disease to more precisely define the role of surgical resection in this group of patients.

METHODS: In this retrospective analysis, we reviewed the records of 78 patients with N2 disease who received induction therapy with preoperative intent between 1990 and 2003. All patients had potentially resectable disease. Survival analysis was performed using the Kaplan-Meier method. A Cox proportional hazards regression model was used to evaluate multiple prognostic factors.

RESULTS: There were 78 patients (39 men) with a median age of 64 years. Sixty had nonsquamous histology. Resection was performed in 52 patients (47 R0). Hospital mortality was 1.9%. A complete pathologic response occurred in 2 of 52 (3.8%) patients and 19 of 52 (36%) patients had no residual N2 disease. Overall 5-year survival for resected patients was 23%. Overall 5-year survival was 30% for N0-N1 patients and 19% for those with residual N2 disease. Multivariable analysis identified clinical response to therapy (p = 0.0007) and histology (p = 0.01), but not residual N2 disease (p = 0.65), as important prognostic variables.

CONCLUSIONS: Surgical resection may be a viable option for patients with residual N2 disease after induction chemotherapy, provided an R0 resection can be performed.




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