The assessment of the possibility in curative resection for primary lung cancer ; video-assisted lobectomy

Abstract

For curative resection of lung cancer, the primary lobe must be resected completely without residual cancer cells being left in the hilar or mediastinal lymph nodes or the adjacent organs. Patients with Ti or T2 lesions (without invasion of a main bronchus), which are pathologically ranked Nla and M0 (but not “pm1”) are potential candidates for curative surgery with video-assisted lobectomy. In our series of 63 candidates the maximum tumor size was 35mm for adenocarcinomas and 45mm for squamous cell carcinomas. In order to confirm that the cancer is pNla or less, at least #3, #4, and #7 lymph node areas for cance of the right lung, and #4, #5, #6, and #7 for cancer of the left lung in addition to the hilar lymph node areas must be examined thoroughly by thoracoscopy or mediastinoscopy, based on our pathological findings of lymphnodes. There were no “pm2” lesions in any of our patients who were graded pN1a or less. In conclusion, curative resection is possible in primary lung cancer under video-assisted surger, when the diameter of the primary lesion is less than 35mm and 45mm for adenocar-cinomas and for squamous cell carcinomas, respectively. In such cases, sampling of medias-tinal lymph nodes is absolutely necessary to confirm N la cases, otherwise standard mediastinal lymph node dissection must be performed.