[Results of surgery for non-small cell lung cancer with N2 involvement unsuspected before thoracotomy].

Objective: To analyze survival in a group of patients with N2 involvement discovered during or after lung resection for non-small cell lung cancer and to evaluate the variables that affect survival.

Patients And Methods: The study included all patients with non-small cell lung cancer who underwent resection between January 1994 and October 2004 and in whom the definitive tumor classification was stage spIIIA due to N2 extension (n=74). Patients with stage spIIIB undergoing induction chemotherapy and patients for whom surgery was considered incomplete were excluded.

Results: Mean survival times were significantly different (P=.002) between resection types: pneumonectomy, 18.1 months (95% confidence interval [CI], 6.9-29.2 months), and lobectomy, 42.4 months (95% CI, 28.7-56.1 months). The number of lymph-node stations affected did not have a significant effect on survival. However, when only 1 station was involved, mean survival was different for lobectomy and pneumonectomy (48.0 months [95% CI, 31-65 months] vs 14.8 months [95% CI, 4.8-24.7 months], respectively; P=.002) but no differences were found when N2 spread involved more than a single station. Adjuvant therapy was used in 50% of cases (n=35): chemotherapy in 6 cases; radiotherapy in 17 cases; and both in 12 cases. The mean survival rate for lobectomy patients with no adjuvant therapy was 31.6 months (95% CI, 15.6-47.5 months) and 46.2 months (95% CI, 32.2-60.1 months) (P=.01) with adjuvant therapy, whereas there were no differences in the group of pneumonectomy patients.

Conclusions: Patients who undergo lobectomy clearly survive longer than those who undergo pneumonectomy when N2 lymph node involvement is found in only 1 station during surgery. Furthermore, adjuvant therapy may increase mean survival times for lobectomy patients.