F-019THE N2 PARADOX: SIMILAR OUTCOMES OF PRE- AND POSTOPERATIVELY IDENTIFIED SINGLE ZONE N2A POSITIVE NON-SMALL LUNG CANCER

• Published in: Interactive cardiovascular and thoracic surgery Vol. 17; no. suppl_1; p. S5
• Main Authors: Tsitsias, Thomas, Boulemden, A., Ang, K., Nakas, A., Waller, D.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.07.2013
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt288.19

Objectives Resection of N2a NSCLC diagnosed preoperatively is controversial but there is support for resection of unexpected N2 disease discovered at surgery. Since the 7th TNM revision we have intentionally resected clinical N2a disease. To validate this policy we determined prognostic factors associated with all resected N2 disease. Methods From a prospective database of 1131 consecutive patients undergoing elective resection for primary lung cancer we identified 68 patients (33 males:35 females, median age 67 years, range 44–82) who had pathological N2 disease. All patients had CT PET staging and selective mediastinoscopy. A Cox-regression analysis was performed to identify prognostic factors. Results At a median follow-up of 13.9 months (range 1-82 months), the overall median survival was 22.2 months (CI 14.6-29.8) months with 1-, 2- and 5-year survival of 63.3%, 46.6% and 13.2% respectively. Survival after resection of pN2 disease is adversely affected by need for pneumonectomy, multi-zone pN2b involvement and by non-compliance with adjuvant chemotherapy. Pathological involvement of the subcarinal zone but no other zone appears to be associated with adverse prognosis (P = 0.063). Importantly, long-term survival is no different between those patients who have a negative preoperative CTPET scan yet are found to have pN2 after resection and those who are single zone cN2a positive before resection on CTPET scan (P = 0.335). Conclusions Our results support a policy of intentionally resecting single zone N2a NSCLC identified preoperatively as part of multimodality therapy. Disclosure All authors have declared no conflicts of interest.