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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 904-910, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
BD Daly, JD Mueller, LJ Faling, JT Diehl, MS Bankoff, DD Karp and WM Rand
Over the past 13 years 681 consecutive patients have undergone computed
tomographic staging and surgical staging of the mediastinum. Five hundred
one tested negative for mediastinal lymph node enlargement by computed
tomographic staging, and 37 of these patients had cancerous mediastinal
lymph nodes at thoracotomy (n = 36) or mediastinoscopy (n = 1). The
survival in this group of patients was analyzed according to T status,
central or peripheral location of tumor, cell type, areas of mediastinum
that are involved, and extent of nodal involvement with tumor. Twelve
patients had central tumors, and 25 had peripheral tumors. Two of the
patients in the central tumor group died postoperatively and only 2 others
survived, whereas 12 of the 25 patients in the peripheral tumor group
survived. Four of the 37 patients, 2 in each group, did not undergo
resection, and all died. All but 2 of the 31 survivors who underwent
resection received postoperative adjuvant x-ray therapy (23 patients),
chemotherapy (1 patient), or x-ray therapy and chemotherapy (5 patients).
The projected 2-year and 5-year survivals (Kaplan-Meier) were 40% and 28%
for patients overall, 46% and 31% for those whose tumors were resected, 40%
and 20% for those with resected central tumors, and 52% and 45% for those
with resected peripheral tumors. None of these differences was significant.
Cell type, location or number of locations of involved nodes, and the
average percentage or maximum percentage of mediastinal node that was
involved with tumor did not influence survival. The high negative
predictive index for computed tomographic staging of the mediastinal lymph
nodes and the observed 2-year and 5-year survivals in patients with
false-negative computed tomographic scans of the chest justifies definitive
thoracotomy without mediastinoscopy in most patients with a normal
mediastinum on computed tomographic scan.
ARTICLES
N2 lung cancer: outcome in patients with false-negative computed tomographic scans of the chest
Department of Cardiothoracic Surgery, Tufts University School of Medicine, Boston, Mass.
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