Limfadenektomia węzłów chłonnych śródpiersia i resekcja miąższu płuca jako standard postępowania w leczeniu raka płuca
Objective: Purpose of the study was to determine the influence of different metastatic infiltration of mediastinal lymph node on prognosis.
Methods: Routine mediastinal lymphadenectomy during lung resection was performed in our department since 1980. Between 1994 and 1997, 753 patient with lung cancer were operated. Operation specimen showed 108 (14.3%) patients with N2 disease.
There were squamos cell carcinoma in 59 cases, adenocarcinoma in 30, small cell carcinoma in 9, and large cell carcinoma, mucoepidermoid and carcinoid tumours in 10. Pneumonectomy was performed in 71 patients, lobectomy in 35 and segmentectomy in 2 cases. The T factors of patients was T1T2 in 63, T3 in 29 and T4 in 16. N2 disease group was dividing into three subgroups: N2 green (N2g) – n-22 – metastases inside the lymph nodes, N2 yellow (N2y) – n-39 – metastases affected lymph node capsule, N2 red (N2r) – n-47 – extracapsular spread of metastases.
Results: 5-years survival for N2 disease patients including postoperative deaths was 25%. Postoperative mortality was 3.7%. Histological type was not influenced on survival in N2 disease patients (p=0.75). T factors had no significant effect on survival (p=0.44). 5-years survival for N2 subgroups was as follow: N2g – 53%, N2y – 23%, N2r – 6,3% (p<0,01). In subgroup N2g, only a single nodal station was involved.
Conclusions: Long term survival of patients from subgroup N2 g and N2y was acceptable. Mediastinal lymphadenectomy in subgroup N2r was not changed bad prognosis. Factor T and histological types was not influenced long-term surviving in N2 disease patients.
Adres: dr hab. Eugeniusz Jadczuk
Katedra i Klinika Chirurgii Klatki Piersiowej AMG
ul. Dębinki, 780-211 Gdańsk
tel. 058 349 24 31