Prognosis of stage pIIIA non small cell lung cancer after mediastinal lymph node dissection or sampling

Purpose: The aim of this study was to define the impact of systematic mediastinal lymph node dissection (MLD) and mediastinal lymph node sampling (MLS) on the long-term results of patients suffering from non-small cell lung cancer (NSCLC) with N2 disease (pIIIA/N2). Patients and methods: From 1999 to 2002, patients with NSCLC in stage pIIIA/N2 were retrospectively classified according to MLD or MLS procedure. Several clinical and pathological factors such as overall survival, disease-free interval, and complications were recorded and analyzed. Results: Ninety-seven (64%) patients were subjected to MLD and 54 (35%) to MLS. Comparison between the two studied groups disclosed more frequent detection of one station pN2 nodes in MLS specimens (p < 0.001), while skip metastasis was more often encountered after MLD (p = 0.05). Duration of the operation, amount of postoperative bleeding and incidence of prolonged air leak were not significantly different between MLD and MLS groups. Cox regression analysis of all cases disclosed squamous histology as the only favourable factor of survival. The disease-free interval was significantly longer after MLD (p < 0.001). Conclusion: Although radical lymphadenectomy did not offer significant prolongation of survival, the disease-free interval was significantly longer after MLD compared with MLS.