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N2 Disease Discovered at Thoracotomy: Resect or Abort?

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Difficult Decisions in Thoracic Surgery

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Abstract

The reported incidence of finding N2 node involvement at thoracotomy which was not anticipated varies from 2%1 to 25%.2–4 However, with good quality staging, it should be less than 10%.1,5 Nevertheless, when N2 node involvement is found intraoperatively, the decision whether to proceed with resection or abort the procedure is difficult. This is the subject of this chapter

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References

  1. Allen MS, Darling GE, Pechet TTV, Mitchell JD, Herndon JE, II, Landreneau RJ, Inculet RI, Jones DR, Meyers BF, Harpole DH, Putnam JB, Jr, Rusch VW, ACOSOG Z0030 Study Group. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 Trial. Ann Thorac Surg. 2006;81:1013–1020.

    Article  PubMed  Google Scholar 

  2. Goldstraw P, Mannam GC, Kaplan DK, Michail P. Surgical management of non-small-cell lung cancer with ipsilateral mediastinal node metastasis (N2 disease). J Thorac Cardiovasc Surg. 1994;107:19–28.

    PubMed  CAS  Google Scholar 

  3. Wada H, Tanaka F, Yanagihara K, Ariyasu T, Fukuse T, Yokomise H, Inui K, Mizuno H, Ike O, Hitomi S. Time trends and survival after operations for primary lung cancer from 1976 through 1990. J Thorac Cardiovasc Surg. 1996;112:349–355.

    Article  PubMed  CAS  Google Scholar 

  4. Naruke T. Significance of lymph node metastases in lung cancer. Semin Thorac Cardiovasc Surg. 1993;5:210–218.

    PubMed  CAS  Google Scholar 

  5. Boffa DJ, Allen MS, Grab JD, Gaissert HA, Harpole DH, Wright CD. Data from The Society of Thoracic Surgeons General Thoracic Surgery database: The surgical management of primary lung tumors. J Thorac Cardiovasc Surg. 2008;135:247–254.

    Article  PubMed  Google Scholar 

  6. Andre F, Grunenwald D, Pignon JP, Dujon A, Pujol J, Brichon P, Brouchet L, Quoix E, Westeel V, Le Chevalier T. Survival of patients with resected N2 non–small-cell lung cancer: evidence for a subclassification and implications. J Clin Oncol. 2000;18:2981–2989.

    PubMed  CAS  Google Scholar 

  7. Detterbeck F. Integration of mediastinal staging techniques for lung cancer. Semin Thorac Cardiovasc Surg. 2007;19:217–224.

    Article  PubMed  Google Scholar 

  8. Detterbeck F, Puchalski J, Rubinowitz A, Cheng D. Classification of the thoroughness of mediastinal staging of lung cancer. Chest. 2009;In Press.

    Google Scholar 

  9. Detterbeck F. What is quality and does it matter? J Thorac Oncol. 2009;4:279–280.

    Article  PubMed  Google Scholar 

  10. Farjah F, Flum D, Ramsey S, Heagerty P, Symons R, Wood DE. Multi-modality mediastinal staging for lung cancer among medicare beneficiaries. J Thorac Oncol. 2009;4:355–363.

    Article  PubMed  Google Scholar 

  11. Detterbeck F. What to do with surprise N2: intraoperative management of patients with non-small cell lung cancer. J Thorac Oncol. 2008;3:289–302.

    Article  PubMed  Google Scholar 

  12. Detterbeck F, Jantz M, Wallace M, Vansteenkiste J, Silvestri G. Invasive Mediastinal Staging of Lung Cancer: an ACCP Evidence Based Clinical Practice Guideline (2nd edition). Chest. 2007;132:202S–220S.

    Article  PubMed  Google Scholar 

  13. Silvestri G, Gould MK, Margolis ML, Tanoue LT, McCrory D, Detterbeck F. Non-invasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd Edition). Chest. 2007;132:178S–201S.

    Article  PubMed  Google Scholar 

  14. Robinson L, Ruckdeschel J, Wagner HJ, Stevens CW. Treatment of non-small cell lung cancer - stage IIIA: ACCP Evidence-based guidelines (2nd Edition). Chest. 2007;132:243S–265S.

    Article  PubMed  Google Scholar 

  15. Kiser AC, Detterbeck FC. General aspects of surgical treatment. In: Detterbeck FC, Rivera MP, Socinski MA, Rosenman JG, eds. Diagnosis and Treatment of Lung Cancer: An Evidence-Based Guide for the Practicing Clinician. Philadelphia, PA: W.B. Saunders; 2001:133–147.

    Google Scholar 

  16. Fang D, Zhang D, Huang G, Zhang R, Wang L. Results of surgical resection of patients with primary lung cancer: a retrospective analysis of 1,905 cases. Ann Thorac Surg. 2001;72:1155–1159.

    Article  PubMed  CAS  Google Scholar 

  17. Watanabe S, Asamura H, Suzuki K, Tsuchiya R. Recent results of postoperative mortality for surgical resections in lung cancer. Ann Thorac Surg. 2004;78:999–1003.

    Article  PubMed  CAS  Google Scholar 

  18. Kohman LJ, Meyer JA, Ikins PM, Oates RP. Random versus predictable risks of mortality after thoracotomy for lung cancer. J Thorac Cardiovasc Surg. 1986;91:551–554.

    PubMed  CAS  Google Scholar 

  19. Deneffe G, Lacquet LM, Verbeken E, Vermaut G. Surgical treatment of bronchogenic carcinoma: a retrospective study of 720 thoracotomies. Ann Thorac Surg. 1988;45:380–383.

    Article  PubMed  CAS  Google Scholar 

  20. Duque JL, Ramos G, Castrodeza J, Cerezal J, Castanedo M, Yuste MG, Heras F, and the Grupo Cooperativo de Carcinoma Broncogenico de la Sociedad Espanola de Neumologia y Cirugia Toracica. Early complications in surgical treatment of lung cancer: a prospective, multicenter study. Ann Thorac Surg. 1997;63:944–950.

    Article  PubMed  CAS  Google Scholar 

  21. Van den Bosch JMM, Gelissen HJ, Wagenaar SS. Exploratory thoracotomy in bronchial carcinoma. J Thorac Cardiovasc Surg. 1983;85:733–737.

    PubMed  CAS  Google Scholar 

  22. Steinbaum SS, Uretzky ID, McAdams HP, Torrington KG, Cohen AJ. Exploratory thoracotomy for nonresectable lung cancer. Chest. 1995;107:1058–1061.

    Article  PubMed  CAS  Google Scholar 

  23. Rami-Porta R, Mateu-Navarro M, Freixinet J, de la Torre M, Jose Torres-Garcia A, Pun Y-W, Canto Armengod A, on behalf of the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic S. Type of resection and prognosis in lung cancer. Experience of a multicentre study. Eur J Cardiothorac Surg. 2005;28:622–628.

    Article  PubMed  Google Scholar 

  24. Dales R, Bélanger R, Shamji F, Leech J, Crépeau A, Sachs H. Quality-of-life following thoracotomy for lung cancer. J Clin Epidemiol. 1994;47:1443–1449.

    Article  PubMed  CAS  Google Scholar 

  25. Nõu E, Aberg T. Quality of survival in patients with surgically treated bronchial carcinoma. Thorax. 1980;35:255–263.

    Article  PubMed  Google Scholar 

  26. Kenny PM, King MT, Viney RC, Boyer MJ, Pollicino CA, McLean JM, Fulham MJ, McCaughan BC. Quality of life and survival in the 2 years after surgery for non-small-cell lung cancer. J Clin Oncol. 2008;26:233–241.

    Article  PubMed  Google Scholar 

  27. Brunelli A, Socci L, Refai M, Salati M, Xiumé F, Sabbatini A. Quality of life before and after major lung resection for lung cancer: a prospective follow-up analysis. Ann Thorac Surg. 2007;84:410–416.

    Article  PubMed  Google Scholar 

  28. Zieren HU, Muller JM, Hamberger U, Pichlmaier H. Quality of life after surgical therapy of bronchogenic carcinoma. Eur J Cardiothorac Surg. 1996;10:233–237.

    Article  PubMed  CAS  Google Scholar 

  29. Win T, Sharples L, Wells FC, Ritchie AJ, Munday H, Laroche CM. Effect of lung cancer surgery on quality of life. Thorax. 2005;60:234–238.

    Article  PubMed  CAS  Google Scholar 

  30. Schulte T, Schniewind B, Dohrmann P, Kuchler T, Kurdow R. The extent of lung parenchyma resection significantly impacts long-term quality of life in patients with non-small cell lung cancer. Chest. 2009;135:322–329.

    Article  PubMed  Google Scholar 

  31. Balduyck B, Hendriks J, Lauwers P, Van Schil P. Quality of life evolution after lung cancer surgery: a prospective study in 100 patients. Lung Cancer. 2007;56:423–431.

    Article  PubMed  CAS  Google Scholar 

  32. Handy JR, Jr., Asaph JW, Skokan L, Reed CE, Koh S, Brooks G, Douville EC, Tsen AC, Ott GY, Silvestri GA. What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery. Chest. 2002;122:21–30.

    Article  PubMed  Google Scholar 

  33. Detterbeck F, Gettinger S, Socinski M. Lung neoplasms. In: Norton J, Barie P, Bollinger R, Chang A, Lowry S, Mulvihill S, Pass HI, Thompson R, eds. Surgery: Basic Science and Clinical Evidence. New York, NY: Springer; 2008:1491–1523.

    Google Scholar 

  34. Wang J, Olak J, Ultmann RE, Ferguson MK. Assessment of pulmonary complications after lung resection. Ann Thorac Surg. 1999;67:1444–1447.

    Article  PubMed  CAS  Google Scholar 

  35. Boysen PG, Harris JO, Block AJ. Prospective evaluation for pneumonectomy using perfusion scanning: follow-up beyond one year. Chest. 1981;80:163–166.

    Article  PubMed  CAS  Google Scholar 

  36. Nezu K, Kushibe K, Tojo T, Takahama M, Kitamura S. Recovery and limitation of exercise capacity after lung resection for lung cancer. Chest. 1998;113:1511–1516.

    Article  PubMed  CAS  Google Scholar 

  37. Van Mieghem W, Demedts M. Cardiopulmonary function after lobectomy or pneumonectomy for pulmonary neoplasm. Respir Med. 1989;83:199–206.

    Article  PubMed  CAS  Google Scholar 

  38. Larsen KR, Svendsen UG, Milman N, Brenoe J, Petersen BN. Cardiopulmonary function at rest and during exercise after resection for bronchial carcinoma. Ann Thorac Surg. 1997;64:960–964.

    Article  PubMed  CAS  Google Scholar 

  39. Markos J, Mullan BP, Hillman DR, Musk AW, Antico VF, Lovegrove FT, Carter MJ, Finucane KE. Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis. 1989;139:902–910.

    Article  PubMed  CAS  Google Scholar 

  40. Bolliger CT, Jordan P, Solèr M et al. Pulmonary function and exercise capacity after lung resection. Eur Respir J. 1996;9:415–421.

    Article  PubMed  CAS  Google Scholar 

  41. Wang J-S, Abboud RT, Wang L-M. Effect of lung resection on exercise capacity and on carbon monoxide diffusing capacity during exercise. Chest. 2006;129:863–872.

    Article  PubMed  Google Scholar 

  42. Nagamatsu Y, Maeshiro K, Kimura NY, Nishi T, Shima I, Yamana H, Shirouzu K. Long-term recovery of exercise capacity and pulmonary function after lobectomy. J Thorac Cardiovasc Surg. 2007;134:1273–1278.

    Article  PubMed  Google Scholar 

  43. Greillier L, Thomas P, Loundou A, Doddoli C, Badier M, Auquier P, Barlesi F. Pulmonary function tests as a predictor of quantitative and qualitative outcomes after thoracic surgery for lung cancer. Clin Lung Cancer. 2007;8:554–561.

    Article  PubMed  Google Scholar 

  44. Pompili C, Brunelli A, Refai M, Xiumè F, Sabbatini A. Does chronic obstructive pulmonary disease affect postoperative quality of life in patients undergoing lobectomy for lung cancer? A case-matched study. Eur J Cardiothorac Surg. 2009;In Press.

    Google Scholar 

  45. Russo SM, Rosenman JG. General aspects of radiotherapy for lung cancer. In: Detterbeck FC, Rivera MP, Socinski MA, Rosenman JG, eds. Diagnosis and Treatment of Lung Cancer: An Evidence-Based Guide for the Practicing Clinician. Philadelphia, PA: W.B. Saunders; 2001:148–161.

    Google Scholar 

  46. Curran W, Moldofsky P, Solin L. Quantitative analysis of the impact of radiation therapy field selection on post-RT pulmonary function. Int J Radiat Oncol Biol Phys. 1988;15(suppl 1):121.

    Google Scholar 

  47. Martinolich D, Rivera MP. Pulmonary assessment and treatment. In: Detterbeck FC, Rivera MP, Socinski MA, Rosenman JG, eds. Chap 7 in: Diagnosis and Treatment of Lung Cancer: An Evidence-Based Guide for the Practicing Clinician. Philadelphia, PA: W.B. Saunders; 2001:113–132.

    Google Scholar 

  48. Abratt R, Wilcox P. The effect of irradiation on lung function and perfusion in patients with lung cancer. Int J Radiat Oncol Biol Phys. 1995;31:915–919.

    Article  PubMed  CAS  Google Scholar 

  49. Mattson K, Holsti LR, Poppius H. Radiation pneumonitis and fibrosis following split-course radiation therapy for lung cancer. Acta Oncologica. 1987;26:193–196.

    Article  PubMed  CAS  Google Scholar 

  50. Socinski MA, Detterbeck FC, Rosenman JG. Adjuvant therapy of resected non-small cell lung cancer. In: Detterbeck FC, Rivera MP, Socinski MA, Rosenman JG, eds. Diagnosis and Treatment of Lung Cancer: An Evidence-Based Guide for the Practicing Clinician. Philadelphia, PA: W.B. Saunders; 2001:206–219.

    Google Scholar 

  51. Douillard J-Y, Rosell R, De Lena M, Carpagnano F, Ramlau R, Gonzales-Larriba JL, Grodzki T, Pereira JR, Le Groumellec A, Lorusso V, Clary C, Torres AJ, Dahabreh J, Souquet P-J, Astudillo J, Fournel P, Artal-Cortes A, Jassem J, Koubkova L, His P, Riggi M, Hurteloup P. Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial. Lancet Oncol. 2006;7:719–727.

    Article  PubMed  CAS  Google Scholar 

  52. Waller D, Peake MD, Stephens RJ, Gower NH, Milroy R, Parmar MK, Rudd RM, Spiro SG. Chemotherapy for patients with non-small cell lung cancer: the surgical setting of the Big Lung Trial. Eur J Cardiothorac Surg. 2004;26:173–182.

    Article  PubMed  CAS  Google Scholar 

  53. Arriagada R, Bergman B, Dunant A, Le Chevalier T, Pignon JP, Vansteenkiste J. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004;350:351–360.

    Article  PubMed  Google Scholar 

  54. Scagliotti GV, Fossati R, Torri V, Crino L, Giaccone G, Silvano G, Martelli M, Clerici M, Cognetti F, Tonato M. Randomized study of adjuvant chemotherapy for completely resected stage I, II, or IIIA non-small-cell Lung cancer. J Natl Cancer Inst. 2003;95:1453–1461.

    Article  PubMed  CAS  Google Scholar 

  55. Keller SM, Adak S, Wagner H, Herskovic A, Komaki R, Brooks BJ, Perry MC, Livingston RB, Johnson DH. A randomized trial of postoperative adjuvant therapy in patients with completely resected stage II or IIIa non-small-cell lung cancer. N Engl J Med. 2000;343:1217–1222.

    Article  PubMed  CAS  Google Scholar 

  56. Cerfolio RJ, Maniscalco L, Bryant AS. The treatment of patients with Stage IIIA non-small cell lung cancer from N2 disease: who returns to the surgical arena and who survives. Ann Thorac Surg. 2008;86:912–920.

    Article  PubMed  Google Scholar 

  57. Alam N, Shepherd FA, Winton T, Graham B, Johnson D, Livingston R, Rigas J, Whitehead M, Ding K, Seymour L. Compliance with post-operative adjuvant chemotherapy in non-small cell lung cancer: An analysis of National Cancer Institute of Canada and intergroup trial JBR.10 and a review of the literature. Lung Cancer. 2005;47:385–394.

    Article  PubMed  Google Scholar 

  58. Thomas M, Rübe C, Hoffknecht P, Macha HN, Freitag L, Linder A, Willich N, Hamm M, Sybrecht GW, Ukena D, Deppermann K-M, Dröge C, Riesenbeck D, Heinecke A, Sauerland C, Junker K, Berdel WE, Semik M. Effect of preoperative chemoradiation in addition to preoperative chemotherapy: a randomised trial in stage III non-small-cell lung cancer. Lancet Oncol. 2008;9:636–648.

    Article  PubMed  Google Scholar 

  59. Albain KS, Swann RS, Rusch VW, Turrisi Iii AT, Shepherd FA, Smith C, Chen Y, Livingston RB, Feins RH, Gandara DR, Fry WA, Darling G, Johnson DH, Green MR, Miller RC, Ley J, Sause WT, Cox JD. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009;374:379–386.

    Article  PubMed  CAS  Google Scholar 

  60. Taylor NA, Liao ZX, Cox JD, Stevens C, Roth J, Walsh G, Chang JY, Guerrero T, Jeter M, Putnam J, Jr., Fossella FV, Allen P, Komaki R. Equivalent outcome of patients with clinical Stage IIIA non-small-cell lung cancer treated with concurrent chemoradiation compared with induction chemotherapy followed by surgical resection. Int J Radiat Oncol Biol Phys. 2004;58:204–212.

    Article  PubMed  Google Scholar 

  61. van Meerbeeck JP, Kramer G, van Schil PE, Legrand C, Smit EF, Schramel FM, Biesma B, Tjan-Heijnen VCG, van Zandwijk N, Giaccone G, Group EO-LC. A randomized trial of radical surgery (S) versus thoracic radiotherapy (TRT) in patients (pts) with stage IIIA-N2 non-small cell lung cancer (NSCLC) after response to induction chemotherapy (ICT) (EORTC 08941). J Clin Oncol. 2005;23:Abstract # 7015.

    Google Scholar 

  62. Hensing TA, Halle JS, Socinki MA. Chemoradiotherapy for stage IIIa, b non-small cell lung cancer. In: Detterbeck FC, Rivera MP, Socinski MA, Rosenman JG, eds. Diagnosis and Treatment of Lung Cancer: An Evidence-Based Guide for the Practicing Clinician. Philadelphia, PA: W.B. Saunders; 2001:291–303.

    Google Scholar 

  63. Jett JR, Schild S, Keith R, Kesler K. Treatment of non-small cell lung cancer - stage IIIb: ACCP Evidenced-Based Clinical Practice Guidelines. Chest. 2007;132:266S–276S.

    Article  PubMed  Google Scholar 

  64. Detterbeck F. Radiographic staging of lung cancer: computed tomography and positron emission tomography. In: Ferguson MK, ed. Difficult Decisions in Thoracic Surgery. New York, NY: Springer; 2007:59–67.

    Chapter  Google Scholar 

  65. MacManus MP, Hicks RJ, Matthews JP, Hogg A, McKenzie AF, Wirth A, Ware RE, Ball DL. High rate of detection of unsuspected distant metastases by PET in apparent stage III non-small-cell lung cancer: implications for radical radiation therapy. Int J Radiat Oncol Biol Phys. 2001;50:287–293.

    Article  PubMed  CAS  Google Scholar 

  66. Eschmann SM, Friedel G, Paulsen F, Budach W, Harer-Mouline C, Dohmen BM, Bares R. FDG PET for staging of advanced non-small cell lung cancer prior to neoadjuvant radio-chemotherapy. Eur J Nucl Med Mol Imaging. 2002;29:804–808.

    Article  PubMed  CAS  Google Scholar 

  67. Weder W, Schmid RA, Bruchhaus H, Hillinger S, von Schulthess GK, Steinert HC. Detection of extrathoracic metastases by positron emission tomography in lung cancer. Ann Thorac Surg. 1998;66:886–893.

    Article  PubMed  CAS  Google Scholar 

  68. Dietlein M, Weber K, Gandjour A, Moka D, Theissen P, Lauterbach KW, Schicha H. Cost-effectiveness of FDG-PET for the management of potentially operable non-small cell lung cancer; priority for a PET-based strategy after nodal-negative CT results. Eur J Nucl Med. 2000;27:1598–1609.

    Article  PubMed  CAS  Google Scholar 

  69. Gould MK, Kuschner WG, Rydzak CE, Maclean CC, Demas AN, Shigemitsu H, Chan JK, Owens DK. Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis. Ann Intern Med. 2003;139:879–892.

    Article  PubMed  Google Scholar 

  70. Serra M, Cirera L, Rami-Porta R, Bastus R, Gonzalez S, Simo M, Domenech M, Barbeta E, Soler JM, Belda J. Routine positron tomography (PET) and selective mediastinoscopy is as good as routine mediastinoscopy to rule out N2 disease in non-small cell lung cancer (NSCLC). J Clin Oncol. 2006;24(suppl):371s.

    Google Scholar 

  71. Cerfolio RJ, Bryant AS, Ojha B, Eloubeidi M. Improving the inaccuracies of clinical staging of patients with NSCLC: a prospective trial. Ann Thorac Surg. 2005;80:1207–1214.

    Article  PubMed  Google Scholar 

  72. Verhagen AFT, Bootsma GP, Tjan-Heijnen VCG, van der Wilt GJ, Cox AL, Brouwer MHJ, Corstens FHM, Oyen WJG. FDG-PET in staging lung cancer: How does it change the algorithm? Lung Cancer. 2004;44:175–181.

    Article  PubMed  CAS  Google Scholar 

  73. Pozo-Rodriguez F, Martin de Nicolas JL, Sanchez-Nistal MA, Maldonado A, Garcia de Barajas S, Calero-Garcia R, Pozo MA, Martin-Escribano P, Martin-Garcia I, Garcia-Lujan R, Lopez-Encuentra A, Arenas de Pablo A. Accuracy of helical computed tomography and [18F] fluorodeoxyglucose positron emission tomography for identifying lymph node mediastinal metastases in potentially resectable non-small-cell lung cancer. J Clin Oncol. 2005;23:8348–8356.

    Article  PubMed  Google Scholar 

  74. Rusch VW, Crowley J, Giroux DJ, Goldstraw P, Im J-G, Tsuboi M, Tsuchiya R, Vansteenkiste J. The IASLC Lung Cancer Staging Project: proposals for the revision of the N descriptors in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol. 2007;2:603–612.

    Article  PubMed  Google Scholar 

  75. Farrell MA, McAdams HP, Herndon JE, Patz EFJ. Non-small cell lung cancer: FDG PET for nodal staging in patients with stage I disease. Radiology. 2000;215:886–890.

    PubMed  CAS  Google Scholar 

  76. Reed C, Harpole D, Posther K, Woolson S, Downey RJ, Meyers BF, Heelan R, MacApinlac H, Jung S-H, Silvestri GA, Siegel BA, Rusch VW. Results of the American College of Surgeons Oncology Group Z0050 Trial: the utility of positron emission tomography in staging potentially operable non-small cell lung cancer. J Thorac Cardiovasc Surg. 2003;126:1943–1951.

    Article  PubMed  Google Scholar 

  77. Viney RC, Boyer MJ, King MT, Kenny PM, Pollicino CA, McLean JM, McCaughan BC, Fulham MJ. Randomized controlled trial of the role of positron emission tomography in the management of stage I and II non-small-cell lung cancer. J Clin Oncol. 2004;22:2357–2362.

    Article  PubMed  Google Scholar 

  78. Detterbeck FC, Jones DR. Surgical treatment of stage IIIa (N2) non-small cell lung cancer. In: Detterbeck FC, Rivera MP, Socinski MA, Rosenman JG, eds. Diagnosis and Treatment of Lung Cancer: An Evidence-Based Guide for the Practicing Clinician. Philadelphia, PA: W.B. Saunders; 2001:244–256.

    Google Scholar 

  79. Vansteenkiste JF, DeLeyn PR, Deneffe GJ, Stalpaert G, Nackaerts KL, Lerut TE, Demedts MG, and the Leuven Lung Cancer Group. Survival and prognostic factors in resected N2 non-small cell lung cancer: a study of 140 cases. Ann Thorac Surg. 1997;63:1441–1450.

    Article  PubMed  CAS  Google Scholar 

  80. Watanabe Y, Shimizu J, Oda M, Hayashi Y, Watanabe S, Tatsuzawa Y, Iwa T, Suzuki M, Takashima T. Aggressive surgical intervention in N2 non-small cell cancer of the lung. Ann Thorac Surg. 1991;51:253–261.

    Article  PubMed  CAS  Google Scholar 

  81. Maggi G, Casadio C, Cianci R, Molinatti M, Filosso PL, Nicolosi M, Oliaro A. Results of surgical resection of Stage IIIA (N2) non small cell lung cancer, according to the site of the mediastinal metastases. Intern Surg. 1993;78:213–217.

    CAS  Google Scholar 

  82. Miller DL, McManus KG, Allen MS, Ilstrup D, Deschamps C, Trastek V, Daly R, Pairolero P. Results of surgical resection of patients with N2 non-small cell lung cancer. Ann Thorac Surg. 1994;57:1095–1101.

    Article  PubMed  CAS  Google Scholar 

  83. Riquet M, Manac’h D, Saab M, Le Pimpec-Barthes F, Dujon A, Debesse B. Factors determining survival in resected N2 lung cancer. Eur J Cardio-Thorac Surg. 1995;9:300–304.

    Article  CAS  Google Scholar 

  84. Martini N, Flehinger BJ, Zaman MB, Beattie Jr EJ. Results of resection in non-oat cell carcinoma of the lung with mediastinal lymph node metastases. Ann Surg. 1983;198:386–397.

    Article  PubMed  CAS  Google Scholar 

  85. Ichinose Y, Kato H, Koike T, Tsuchiya R, Fujisawa T, Shimizu N, Watanabe Y, Mitsudomi T, Yoshimura M. Overall survival and local recurrence of 406 completely resected stage IIIa-N2 non-small cell lung cancer patients: questionnaire survey of the Japan Clinical Oncology Group to plan for clinical trials. Lung Cancer. 2001;34:29–36.

    Article  PubMed  CAS  Google Scholar 

  86. Mountain CF. Expanded possibilities for surgical treatment of lung cancer: survival in stage IIIa disease. Chest. 1990;97:1045–1051.

    Article  PubMed  CAS  Google Scholar 

  87. Tanaka F, Yanagihara K, Ohtake Y, Fukuse T, Hitomi S, Wada H. Time trends and survival after surgery for p-stage IIIa, pN2 non-small cell lung cancer (NSCLC). Eur J Cardiothorac Surg. 1997;12:372–379.

    Article  PubMed  CAS  Google Scholar 

  88. Thomas PA, Piantadosi S, Mountain CF. Should subcarinal lymph nodes be routinely examined in patients with non-small cell lung cancer? J Thorac Cardiovasc Surg. 1988;95:883–887.

    Google Scholar 

  89. Suzuki K, Nagai K, Yoshida J, Nishimura M, Takahashi K, Nishiwaki Y. The prognosis of surgically resected N2 non-small cell lung cancer: the importance of clinical N status. J Thorac Cardiovasc Surg. 1999;118:145–153.

    Article  CAS  Google Scholar 

  90. UICC. TNM Classification of Malingnant Tumors. Hoboken: Wiley-Blackwell; 2009.

    Google Scholar 

  91. Detterbeck F, Boffa DJ, Tanoue L, Wilson L. Details, difficulties and dilemmas regarding the new lung cancer staging system. Chest. 2010;submitted.

    Google Scholar 

  92. Vansteenkiste JF, De Leyn PR, Deneffe GJ, Lerut TE, Demedts MG. Clinical prognostic factors in surgically treated stage IIIA-N2 non-small cell lung cancer: analysis of the literature. Lung Cancer. 1998;19:3–13.

    Article  PubMed  CAS  Google Scholar 

  93. Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Matsuoka H. Prognosis of completely resected pN2 non-small cell lung carcinomas: what is the significant node that affects survival? J Thorac Cardiovasc Surg. 1999;118:270–275.

    Article  PubMed  CAS  Google Scholar 

  94. Watanabe Y, Hayashi Y, Shimizu J, Oda M, Iwa T. Mediastinal nodal involvement and the prognosis of non-small cell lung cancer. Chest. 1991;100:422–428.

    Article  PubMed  CAS  Google Scholar 

  95. Watanabe S, Ladas GP, Goldstraw P. Inter-observer variability in systematic nodal dissection: comparison of European and Japanese nodal designation. Ann Thorac Surg. 2002;73:245–248.

    Article  PubMed  Google Scholar 

  96. Rusch V, Asamura H, Watanabe H, Giroux D, Rami-Porta R, Goldstraw P, Members of the IASLC Staging Committee. The IASLC Lung Cancer Staging Project: a proposal for a new international lymph node map in the forthcoming 7th edition of the TNM classification for lung cancer. J Thorac Oncol. 2009;4:568–577.

    Article  PubMed  Google Scholar 

  97. Cheng D, Downey RJ, Kernstine K, Stanbridge R, Shennib H, Wolf R, Ohtsuka T, Schmid R, Waller D, Fernando H, Yim A, Martin J. Video-assisted thoracic surgery in lung cancer resection: a meta-analysis and systematic review of controlled trials. Innovations. 2007;2:261–292.

    PubMed  Google Scholar 

  98. Detterbeck F. Thoracoscopic vs. open lobectomy debate: the pro argument. Thorac Surg Sci. 2009;(accepted).

    Google Scholar 

  99. Li WW, Lee TW, Lam SS, Ng CS, Sihoe AD, Wan IY, Yim AP. Quality of life following lung cancer resection: video-assisted thoracic surgery vs thoracotomy. Chest. 2002;122:584–589.

    Article  PubMed  Google Scholar 

  100. Petersen RP, Pham D, Burfeind WR, Hanish SI, Toloza EM, Harpole JDH, D’Amico TA. Thoracoscopic lobectomy facilitates the delivery of chemotherapy after resection for lung cancer. Ann Thorac Surg. 2007;83:1245–1250.

    Article  PubMed  Google Scholar 

  101. Pearson FG, DeLarue NC, Ilves R, Todd TRJ, Cooper JD. Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J Thorac Cardiovasc Surg. 1982;83:1–11.

    PubMed  CAS  Google Scholar 

  102. Coughlin M, Deslauriers J, Beaulieu M, Fournier B, Piraux M, Rouleau J, Tardif A. Role of mediastinoscopy in pretreatment staging of patients with primary lung cancer. Ann Thorac Surg. 1985;40:556–560.

    Article  PubMed  CAS  Google Scholar 

  103. Mansour Z, Kochetkova EA, Santelmo N, Ducrocq X, Quoix E, Wihlm J-M, Massard G. Persistent N2 disease after induction therapy does not jeopardize early and medium term outcomes of pneumonectomy. Ann Thorac Surg. 2008;86:228–233.

    Article  PubMed  Google Scholar 

  104. Régnard JF, Magdeleinat P, Azoulay D, Dartevelle P, Deneuville M, Rojas-Miranda A, Levasseur P. Results of resection for bronchogenic carcinoma with mediastinal lymph node metastases in selected patients. Eur J Cardiothorac Surg. 1991;5:583–587.

    Article  PubMed  Google Scholar 

  105. Cybulsky I, Lanza L, Ryan M, Putnam Jr J, McMurtrey M, Roth J. Prognostic significance of computed tomography in resected N2 lung cancer. Ann Thorac Surg. 1992;54:533–537.

    Article  PubMed  CAS  Google Scholar 

  106. Inoue M, Sawabata N, Takeda S, Ohta M, Ohno Y, Maeda H. Results of surgical intervention for p-stage IIIA (N2) non-small cell lung cancer: acceptable prognosis predicted by complete resection in patients with single N2 disease with primary tumor in the upper lobe. J Thorac Cardiovasc Surg. 2004;127:1100–1106.

    Article  PubMed  Google Scholar 

  107. Tanaka F, Yanagihara K, Otake Y, Kawano Y, Miyahara R, Takenaka K, Katakura H, Ishikawa S, Ito H, Wada H. Prognostic factors in resected pathologic (p-) Stage IIIA-N2, non-small-cell lung cancer. Ann Surg Oncol. 2004;11:612–618.

    Article  PubMed  Google Scholar 

  108. Daly B, Mueller J, Faling L, Diehl J, Bankoff M, Karp D, Rand W. N2 lung cancer: outcome in patients with false-negative computed tomographic scans of the chest. J Thorac Cardiovasc Surg. 1993;105:904–911.

    PubMed  CAS  Google Scholar 

  109. Sakao Y, Miyamoto H, Yamazaki A, Oh T, Fukai R, Shiomi K, Saito Y. Prognostic significance of metastasis to the highest mediastinal lymph node in nonsmall cell lung cancer. Ann Thorac Surg. 2006;81:292–297.

    Article  PubMed  Google Scholar 

  110. Ishida T, Tateishi M, Kaneko S, Sugimachi K. Surgical treatment of patients with nonsmall-cell lung cancer and mediastinal lymph node involvement. J Surg Oncol. 1990;43:161–166.

    Article  PubMed  CAS  Google Scholar 

  111. Maggi G, Casadio C, Mancuso M, Oliaro A, Cianci R, Ruffini E. Resection and radical lymphadenectomy for lung cancer: prognostic significance of lymphatic metastases. Int Surg. 1990;75:17–21.

    PubMed  CAS  Google Scholar 

  112. Rea F, Marulli G, Callegaro D, Zuin A, Gobbi T, Loy M, Sartori F. Prognostic significance of main bronchial lymph nodes involvement in non-small cell lung carcinoma: N1 or N2? Lung Cancer. 2004;45:215–220.

    Article  PubMed  Google Scholar 

  113. Iwasaki A, Shirakusa T, Miyoshi T, Hamada T, Enatsu S, Maekawa S, Hiratsuka M. Prognostic significance of subcarinal station in non-small cell lung cancer with T1 - 3 N2 disease. Thorac Cardiovasc Surg. 2006;54:42–46.

    Article  PubMed  CAS  Google Scholar 

  114. Okada M, Tsubota N, Yoshimura M, Miyamoto Y, Nakai R. Evaluation of TMN classification for lung carcinoma with ipsilateral intrapulmonary metastasis. Ann Thorac Surg. 1999;68:326–331.

    Article  PubMed  CAS  Google Scholar 

  115. Conill C, Astudillo J, Verger E. Prognostic significance of metastases to mediastinal lymph node levels in resected non-small cell lung carcinoma. Cancer. 1993;72:1199–1202.

    Article  PubMed  CAS  Google Scholar 

  116. Ohta Y, Shimizu Y, Minato H, Matsumoto I, Oda M, Watanabe G. Results of initial operations in non–small cell lung cancer patients with single-level N2 disease. Ann Thorac Surg. 2006;81:427–433.

    Article  PubMed  Google Scholar 

  117. De Leyn P, Schoonooghe P, Deneffe G, Van Raemdonck D, Coosemans W, Vansteenkiste J, Lerut T. Surgery for non-small cell lung cancer with unsuspected metastasis to ipsilateral mediastinal or subcarinal nodes (N2 disease). Eur J Cardiothorac Surg. 1996;10:649–655.

    Article  PubMed  CAS  Google Scholar 

  118. Cerfolio RJ, Bryant AS. Survival of patients with unsuspected N2 (Stage IIIA) nonsmall-cell lung cancer. Ann Thorac Surg. 2008;86:362–367.

    Article  PubMed  Google Scholar 

  119. Mangione CM, Goldman L, Orav EJ, Marcantonio ER, Pedan A, Ludwig LE, Donaldson MC, Sugarbaker DJ, Poss R, Lee TH. Health-related quality of life after elective surgery: measurement of longitudinal changes. J Gen Intern Med. 1997;12:686–697.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA

    Frank C. Detterbeck

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  1. Dept. Surgery, Mail Code 5035, University of Chicago, S. Maryland Avenue 5841, Chicago, 60637, Illinois, USA

    Mark K. Ferguson

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Detterbeck, F.C. (2011). N2 Disease Discovered at Thoracotomy: Resect or Abort?. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Springer, London. https://doi.org/10.1007/978-1-84996-492-0_9

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