Complete resection via medial sternotomy for non-small cell lung cancer in the right upper lobe

Background: Right upper lobectomy with right cervical and bilateral mediastinal lymph node dissection via a median approach was performed for non‐small cell lung cancer. Methods: From 1995 to 2003, 48 patients aged ≤ 70 years underwent resection of cancer in the right upper lobe, including 26 with N0, four with N1 and 18 with N2 disease. Results: Metastases to the right cervical, highest mediastinal, pretracheal and bilateral tracheobronchial lymph nodes were frequent. There were no operative or hospital deaths. Preoperative accuracy of N‐factor diagnosis was only 35.4%. The overall 5‐year survival rate was 58.8%. The rate for C‐N2 disease (n = 18) was 42.6%, and the rate for p‐N2 disease (n = 7) and p‐N3 disease (n = 13) was 57.1% and 0%, respectively, using the Kaplan−Meier method. Conclusions: Patients without N3 disease have a good prognosis, and extended and systematic radical lymphadenectomy via median sternotomy improves the staging, and possibly the prognosis of pure N2 disease.