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Ann Thorac Surg 2009;88:200-205. doi:10.1016/j.athoracsur.2009.04.005
© 2009 The Society of Thoracic Surgeons
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Marc Riquet
Emmanuel Brian
Claudia Vlas
Patrick Bagan
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Original Articles: General Thoracic

Intrathoracic Lymph Node Metastases From Extrathoracic Carcinoma: The Place for Surgery

Marc Riquet, MD*, Pascal Berna, MD, Emmanuel Brian, MD, Alain Badia, MD, Claudia Vlas, MD, Patrick Bagan, MD, Françoise Le Pimpec Barthes, PhD, MD

Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France

Accepted for publication April 1, 2009.

* Address correspondence to Dr Riquet, Thoracic Surgery Department, Georges Pompidou European Hospital, 20 rue Leblanc, Paris, 75015, France (Email: marc.riquet{at}egp.aphp.fr).

Background: Intrathoracic hilar or mediastinal lymph node metastases (HMLNMs) of extrathoracic carcinomas are infrequent. Their treatment strategy is not established and their prognosis poorly known. We reviewed the place of surgical intervention in their management.

Methods: Among 565 patients with mediastinal lymph node enlargement, 37 had a history of extrathoracic carcinoma. The enlargement consisted in HMLNMs in 26 (15 men, 11 women), with a mean age of 57.6 (range 19-78) years. Surgical procedures were reviewed.

Results: Diagnostic procedures, comprising mediastinoscopy in 9, anterior mediastinotomy in 2, and video-assisted thoracic surgery (VATS) in 4, were performed mainly because of unresectability due to diffuse and bilateral HMLNMs. Cancer location was breast in 6, kidney or prostate in 2 each, and bladder, rectum, testis, melanoma, and larynx in 1 each. Median survival was 21 months. Resection was performed in 11 patients, comprising posterolateral thoracotomy in 6, muscle sparing thoracotomy in 2, and VATS in 3. Seventeen involved LN stations were removed; of these, primary were kidney in 3, testis or thyroid in 2 each, and larynx, nasopharynx, and intestinum in 1 each. Five-year survival was 41.6% (median, 45 months).

Conclusions: HMLNMs of extrathoracic carcinoma may be isolated, probably in the context of a particular lymphatic mode of spread. Our experience demonstrates that operation is mainly diagnostic but resection may safely achieve local control of the disease and deserves being advocated in patients with isolated and resectable HMLNMs.


Related Article

Invited Commentary
Eddie Hoover
Ann. Thorac. Surg. 2009 88: 205. [Extract] [Full Text] [PDF]



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E. Hoover
Invited commentary.
Ann. Thorac. Surg., July 1, 2009; 88(1): 205 - 205.
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