2006 Volume 20 Issue 6 Pages 811-818
«Background»Although the main lymphatic drainage from the right middle lobe (RML) is usually by an inferior bronchial pathway passing via the subcarinal nodes, in some cases a route into the upper mediastinal nodes via the upper lobe node (#12u) has been reported. We have performed selective #12u dissection in addition to standard dissection (ND2a) in patients with non-small cell lung cancers (NSCLCs) in the RML. However, only limited information is available regarding the value of #12u dissection.«Patients and Methods»Between January 1980 and October 2004 complete resection was performed for 133 patients with NSCLCs of the RML. Among these, 86 patients with ND2a dissection were reviewed here. Patients with multiple lung cancers were excluded.«Result»Dissection of #12u nodes was performed for 47 out of 86 patients. The operative procedures were as follows: middle lobectomy for 26; upper and middle bilobectomy for 15; middle and lower bilobectomy for two; and pneumonectomy for four patients. The stage distribution according to #12u dissection was as follows: among patients with #12u dissection, 25 were stage I, five were II and 17 were III; among 39 without #12u dissection, 32 were stage I, two were II and five were III. The difference between the two approaches was statistically significant (P=0.018). Lymph node metastases included N1 disease in eight patients (9%) and N2 in 13 (15%). Among N1 cases, none were #12u-positive. Only two patients with N2 disease had #12u metastases. In these patients, multiple metastases were associated with a poor prognosis. The five-year survival rate for all 86 patients was 72%, and for these with and without #12u dissection, 68% and 78%, respectively (P=0. 320). Twenty five out of 86 patients (29%) suffered cancer recurrence, 21 patients out of 47 with (45%) and four out of 39 without #12u dissection (10%). As to the initial recurrence sites, 18 patients (67%) had distant relapse and the other nine (33%) local relapse. However, no patients demonstrated local recurrence at #12u lymph nodes.«Conclusions»Although the rate of metastasis to #12u nodes was low for cases of NSCLC in the RML, patients with such disease had a poor prognosis. No significant difference in survival was evident with reference to #12u dissection and there was no case with local recurrence at #12u nodes after ND2a resection. Therefore, dissection of #12u may not be indicated for NSCLCs in the RML.
