No abstract

Radical systematic mediastinal lymphadenectomy does not influence disease-free or overall survival in patients with NSCLC and without overt lymph node involvement. However, a small subgroup of patients with limited mediastinal lymph node metastases might benefit from a systematic lymphadenectomy.

The immunohistochemical detection of disseminated tumor cells in lymph nodes of patients with completely resected NSCLC is an independent prognostic factor for overall survival.

Our results provide evidence that the presence of single lung carcinoma cells in lymph nodes is an independent indicator of the disseminatory capacity of an individual primary tumor. Immunohistochemical assessment of micrometastases in lymph nodes is recommended for current tumor staging in NSCLC, as it might lead to better stratification of patients for adjuvant therapy.

The value of radical systematic lymphadenectomy in the treatment of bronchial carcinoma is controversial. In a randomized controlled clinical trial, radical lymphadenectomy was compared with conventional node dissection in 182 patients with non-small cell lung cancer. Comparison of short-term results revealed a sigdflcantly longer operating time in those undergoing systematic lymphadenectomy, but overall morbidity and mortality rates were comparable between groups. However, there were compli-The only treatment with a chance of cure for patients with localized non-small cell lung cancer is a radical operation such as classical lobectomy or pneumonectomy. To what extent lymphadenectomy contributes to the chance of cure remains controversial.Some authors' ' advocate radical systematic mediastinal lymphadenectomy as a conditio sine qua non; it is even claimed3s4 that pulmonary resection without mediastinal lymph node dissection has to be considered a palliative operation, denying the patient a chance of cure. In some centres this treatment policy has led to ultraradical operations, mostly in left-sided lung cancers, where bilateral mediastinal lymphadenectomy via a median sternotomy is combined with the classical tumour operation3s5. Other surgeons, such as those of the American Lung Cancer Study Group, have advocated nodal sampling onlyG8 to avoid increasing the morbidity and mortality rates because of the extent of operation. A firm rational basis for extensive systematic lymph node dissection of the ipsilateral thoracic cavity does not emerge from the literat~re~.'~. Benefit has been shown only against historical controls or patients who were excluded from the treatment for other medical reasons3. Since it is unclear which patient categories will benefit from this extensive operation, McKneallyg has emphasized the need for a randomized controlled trial to evaluate the therapeutic efficacy of systematic lymph node dissection. Such a trial was devised to compare the results of conventional lymph node dissection with those of radical systematic lymphadenectomy in patients undergoing curative resection of non-small cell lung cancer. Patients and methodsThe trial was approved by the Ethical Research Committee of the Medical Faculty, University of Munich. Patients were evaluated, randomized, treated and followed up at the Department of Surgery, University of Munich, and the Division of Thoracic Surgery and Department of Pulmonary Medicine, Central Hospital Gauting.Paper accepted 11 July 1993 cations associated with radical lymphadenectomy such as prolonged air leakage and haemorrhage. Interim analysis of results at a median follow-up of 26.8 months showed no significant influence of radical lymphadenectomy on local recurrence-free interval, metastasis-free interval or cancer-related survival. In conclusion, radical systematic lymphadenectomy is a safe operation that leads to a better staging of non-small cell lung cancer, but its prognostic benefit k questionable. Eligibility criteriaPatients of any age and sex with a c...