Ann Thorac Surg 1999;67:907
© 1999 The Society of Thoracic Surgeons
Commentary
John R. Benfield, MDa
a University of California Davis Medical Center, Sacramento, CA 95817, USA
Invited commentary
This retrospective analysis of 123 patients representing about 6% of a 16-year experience is noteworthy because all patients had negative mediastinoscopy. Thus, preoperative staging was more uniform and more complete than it is in most reports.
It is no surprise that the type of lymph node involvement did not relate to survival, that the survival of patients with cancers extending into the nodes did not differ from that of patients with metastases to the nodes in the same region, and that spread to hilar lymph nodes was associated with survival rates that approximate survival among patients with N2 or ipsilateral mediastinal spread. The last observation underscores the limitations of our staging system because the distance between hilar and ipsilateral mediastinal nodes is usually a matter of a few centimeters or less. How could it make biological sense to expect a difference in outcome based on such considerations of location? The issue is whether there is any lymph node spread at all.
The fact that the cumulative postoperative survival rate among patients with stage III N1 lung cancer at 5 years was 27.2% is also noteworthy. These patients did not have induction therapy, and the outcome is about the same as published results after induction or neoadjuvant therapy for stage III carcinoma of the lung. This finding supports the idea that complete resection is still the best treatment of carcinoma of the lung, when it can be accomplished safely. However, the 18.6% mortality rate among patients who had T4 N1 cancers is too high. Today’s combination nonoperative therapy would likely have given some of those patients some additional months of life with reasonable quality. Sometimes it is a sign of good judgment, not a sign of surgical inadequacy, to decide to forgo a major resection when lung cancer patients have proven lymph node metastases.
Related Article
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Type of lymph node involvement and survival in pathologic N1 stage III non–small cell lung carcinoma
- Edwin van Velzen, Aart Brutel de la Rivière, Hans J.J. Elbers, Jan-Willem J. Lammers, and Jules M.M. van den Bosch
Ann. Thorac. Surg. 1999 67: 903-907.
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