Positive Hilar Nodes Research Articles

Prevalence and Pattern of Lymph Node Metastasis in Malignant Pleural Mesothelioma

The incidence and pattern of nodal metastases in mesothelioma are not well understood. This study was conducted to evaluate the prevalence and pattern of nodal metastasis in mesothelioma patients. The study included 53 patients with mesothelioma. The first 37 patients (group I) underwent combined modality treatment without preoperative mediastinoscopy. The second group included 16 patients (group II) with pretreatment mediastinoscopy. A total of 18 patients had positive lymph nodes, 12 in group I and 6 in group II; of the latter, 4 had positive mediastinoscopy and 2 had positive nodes on final pathology. Postoperatively, a mean of 14 nodes were dissected (range, 5 to 34). In the post-pleuropneumonectomy group, 6 of 14 patients had positive hilar node metastases in addition to positive mediastinal lymph nodes. One patient had positive hilar nodes only. Of the 49 patients operated on, only 7 had no lung invasion by pathologic evaluation, and none had positive hilar nodes. The mechanism of spread of the disease to hilar nodes may be through lung invasion and not due to direct spread from the pleura. This observation raises the possibility that mediastinal nodes should be considered the primary station in patients with mesothelioma, whereas hilar node metastasis necessitated lung invasion first. The pattern of nodal metastases may be different from that of lung cancer, and multicenter studies are needed to evaluate this observation.

STAGE III A & B NON-SMALL CELL LUNG CANCER

Stage IIIA Non- Small Cell Lung Cancer (NSCLC) is characterized by the presence of ipsilateral mediastinal and / or sub carinal nodal involvement (N2) associated with a T1 or T2 primary lesion or a T3 lesion associated either with positive hilar nodes (N1) or with N2 nodal disease. Stage IIIB disease is characterized by scalene, supra-clavicular, contra lateral mediastinal, or contralateral hilar lymph node involvement (N3) associated with any T category or a T4 primary tumor associated with any N category1. Patients with stage IIIA disease can be stratified into those with bulky and nonbulky disease, based upon the presence of lymph nodes >2 cm in short-axis diameter, or groupings of multiple smaller lymph nodes 2. Patients with bulky stage IIIA or those with stage IIIB disease are generally considered inoperable.

One hundred and one cases of bronchoplasty for primary lung cancer.

The results of 101 consecutive bronchoplasties performed between 1979 and 1993, including 8 cases of pneumonectomy, 88 cases of lobectomy, 3 cases of segmentectomy, and 2 cases of bronchial resection, are herein reported. Squamous cell carcinoma was the most common disease (59%) followed by adenocarcinoma (30%) and other diseases (11%). Anastomosis was satisfactory in 96 cases. Among the five stenosed cases, local recurrence was found in two cases, and there were three benign strictures. Two of the three benign strictures were treated with bouginage. The pulmonary artery was concomitantly reconstructed in seven cases with satisfactory results. Preoperative chemoradiotherapy was performed in 15 advanced cases and was followed by acceptable surgical results. The 5-year survival rate, according to the postoperative staging of the 86 patients without induction therapy, was 86% in stage I (19 patients), 49% in stage II (21 patients), and 27% in stage IIIA (40 patients). The overall survival rate was 46% at 5 years. There were two indications for this procedure i.e., a positive resection margin in 59 cases and positive hilar nodes in 42 cases. Better survival was noted in patients with squamous cell carcinoma, stage I, and surgery was thus selected for a positive resection margin, and not for a positive node.