The current guidelines for the evaluation of mediastinal lymph nodes in the setting of lung cancer include EBUS with fine-needle aspiration and cytological evaluation to be enlarged on computed tomography (CT; short axis ≥1 cm). Optimal management of clinical stage IIIA (N2) NSCLC is controversial. This study is a systematic review and meta-analysis of published randomized control trials of multimodality management strategies for NSCLC. We conducted a comprehensive literature search of the Pubmed databases for relevant studies comparing patients with stage IIIA (N2) NSCLC undergoing surgery alone, chemotherapy and/or radiotherapy alone, or surgical resection after neoadjuvant treatment with chemotherapy and/or radiotherapy. We estimated hazard ratios, odds ratios (ORs), and 95% confidence intervals (CIs) for survival data. There was no significant difference in overall survival (OS) or progression-free survival (PFS) in stage IIIA (N2) NSCLC patients who received neoadjuvant chemotherapy or chemoradiotherapy prior to surgical resection compared to those who received neoadjuvant chemotherapy or chemoradiotherapy prior to radical radiotherapy. There was a significant increase in pathological complete remission in the mediastinal lymph nodes in stage IIIA (N2) NSCLC patients who received neoadjuvant chemoradiotherapy prior to surgical resection compared to those who received neoadjuvant chemotherapy. In general, North American surgeons are more likely to surgically stage the mediastinum before operation, are less likely to offer surgical treatment when N2 disease is identified preoperatively and are more likely to use induction therapy before resection. In contrast, European surgeons may offer operation as the initial treatment followed by adjuvant therapy inselected cases of N2 disease, and they may perform a more aggressive intraoperative nodal dissection. Neoadjuvant chemotherapy and/or radiotherapy prior to surgical resection do not appear to be clinically superior to neoadjuvant chemotherapy and/or radiotherapy prior to definitive radiotherapy in IIIA (N2) NSCLC patients