Results of surgical resection in patients with N2 non-small cell lung cancer.

From January 1982 to December 1986, 167 patients (121 men and 46 women) with non-small cell lung cancer and a clinically negative mediastinum were found to have N2 lymph node metastases at thoracotomy and underwent pulmonary resection. Ages ranged from 31 to 86 years (median, 66 years). Adenocarcinoma was present in 70 patients (41.9%), squamous cell carcinoma in 64 (38.3%), large cell carcinoma in 20 (12.0%), adenosquamous cell carcinoma in 7 (4.2%), and bronchoalveolar cell carcinoma in 6 (3.6%). Forty-seven patients (28.1%) underwent mediastinoscopy; all results were negative. Pneumonectomy was performed in 64 patients, bilobectomy in 4, lobectomy in 76, segmentectomy in 2, and wedge excision in 21. Twenty patients had an incomplete resection. Thirty-five patients (21.0%) had complications, and the operative mortality was 4.8% (8 of 167 patients). Sixty-seven patients (40.1%) received adjuvant radiation therapy. The 5-year survival for the 147 patients who underwent complete resection was 23.7%. In contrast, 19 of the 20 patients (95.0%) who underwent incomplete resection died within 3 years. Other factors that significantly affected the 5-year survival were the number and location of metastatic lymph node stations, age, type of resection, and whether adjuvant radiation therapy was administered. We conclude that, when N2 disease is found at thoracotomy, complete resection is warranted to achieve long-term survival.