Mediastinal Lymph Node Dissection for Non-small Cell Lung Cancer in Left Lung

Objeetive: The aim of this study was to evaluate the feasi-bility of limited mediastinal lymphadenectomy for cancer inthe left lung in patients without mediastinal lymph node metastases, and to discuss the significance of ex-tended systemicmediastinal lymphadenectomy for patients with left lung cancer who had mediastinal lymph nodes me-tastases. Patients and Methods: We retrospectively analyzed the cl-inical records of patients who had been operated for nonsmallcell lung cancer in the left lung. The patients were classified according to the N factor and their records ex-aminedfor prognosis, recurrent site and the relation of metastatic mediastinal lymph nodes with location of the primary tumor. Results: There were 114 patients with p N0 disease. The 5-year survival rate was 78.1% for patients undergoingcompl-ete mediastinal lymphadenectomy (n=27) and 69.5% for those with incomplete lymphadenectomy (n=87). Therewere 48 pati-ents with p N1 disease. The 5-year survival rate was 37.9% for patients with left lung cancer undergoing completemediastinal lymphadenectomy (n=23) and 52.0% for those with incomplete lymphadenectomy (n=25). There wereno statistic-ally significant differences between complete cases and incomplete cases. As for the relation between the primarysite of the cancer with N2 stations, all left upper lobe lesions (n=42) metastasized to # 4 and/or # 5 and/or # 6, whole left lower lobe lesions (n=16) metastasized to # 4 and/or # 5 and/or # 7. Three patients with left lower lobe lesionsand p N2 disease had recurrence in contralateral mediastinal nodes, but no patients had recurrence in contralateralmediastinal nodes in the left upper lobe lesions. Conclusion: Limited mediasinal lymphadenectomy was sug-ested to be feasible in patients with p N0, p N1 disease inthe left lung. Systematic extended mediastinal lymph n-ode dissection was suggested to be useful for patients who hadmetastasis in # 7 and no metastasis in # 1-4 and # 8, # 9 in the left lower lobe.