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Ann Thorac Surg 2007;84:1059-1065
© 2007 The Society of Thoracic Surgeons

Review

Surgical Assessment and Intraoperative Management of Mediastinal Lymph Nodes in Non-Small Cell Lung Cancer

Bryan A. Whitson, MD, Shawn S. Groth, MD, Michael A. Maddaus, MD*

University of Minnesota Department of Surgery, Section of Thoracic and Foregut Surgery, Minneapolis, Minnesota

* Address correspondence to Dr Maddaus, University of Minnesota Department of Surgery, MMC 207, 420 Delaware St SE, Minneapolis, MN 55455 (Email: madda001{at}umn.edu).

Mediastinal lymph node status has important prognostic and therapeutic implications for nonsmall cell lung cancer patients. Consequently, an accurate pathologic assessment of mediastinal lymph nodes for metastasis is essential. Despite the significance of nodal assessment, practice patterns among surgeons vary widely. Therefore we reviewed the literature to provide evidence-based recommendations regarding the ideal means and extent of preoperative and intraoperative pathologic mediastinal lymph node staging in non-small cell lung cancer patients. We found that the most sensitive and accurate intraoperative method is a complete mediastinal lymph node dissection. Pathologic evaluation of at least 10 mediastinal lymph node from at least three stations should be performed at the time of surgery.




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