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Vol. 36. Issue 7.
Pages 365-370 (July - August 2000)
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Vol. 36. Issue 7.
Pages 365-370 (July - August 2000)
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Resultados del tratamiento quirúrgico del carcinoma broncogénico N2 patológico con mediastinoscopia negativa
Results of surgical treatment of N2 bronchogenic carcinoma with negative mediastinoscopy
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R. Rami Porta
Corresponding author
rramip@teleline.es

Correspondencia: Sección de Cirugía Torácica. Hospital Mútua de Terrassa. Plaza Dr. Robert, 5. 08221 Terrassa. Barcelona.
, M. Mateu Navarro, M. Cuesta Palomero
Sección de Cirugía Torácica. Hospital Mútua de Terrassa. Terrassa. Barcelona
G. González Pont*
* Sección de Cirugía Torácica, Servicio de Anatomía Patológica. Hospital Mútua de Terrassa. Terrassa. Barcelona.
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Objetivo

Análisis de la supervivencia de los pacientes con carcinoma broncogénico N2 patológico y mediastinoscopia negativa sometidos a resección pulmonar.

Material y método

Se analizan 29 pacientes con carcinoma broncogénico N2 patológico de una serie total de 170 pacientes intervenidos entre 1993 y 1997 y registrados en el Grupo Cooperativo de Carcinoma Broncogénico de la SEPAR (GCCB-S). Veintiséis pacientes presentaron afectación ganglionar en mediastino superior y tres en las estaciones del ligamento pulmonar o paraesofágica. Once casos presentaron afectación extracapsular. Tres pacientes que fallecieron en el postoperatorio se excluyeron del análisis de supervivencia.

Resultados

La supervivencia a los 5 años de los 170 pacientes fue del 39%. La supervivencia a los 5 años de los 26 pacientes con N2 patológico incluidos en el análisis fue del 14%, con una mediana de 12 meses. La supervivencia a 5 años del resto de la serie, excluyendo los N2 patológicos, fue del 46%. Aunque la mediana de supervivencia para los pacientes con afectación intracapsular fue de más del doble (25 meses) que la de los pacientes con afectación extracapsular (12 meses), las diferencias no fueron significativas.

Conclusiones

La resección pulmonar en pacientes con carcinoma broncogénico N2 patológico con mediastinoscopia negativa tiene poco impacto en la supervivencia. La exploración quirúrgica del mediastino selecciona a estos pacientes con la máxima certeza clasificadora; aunque sería de desear que la sensibilidad de estas técnicas se incrementara para evitar que estos pacientes lleguen a precisar la toracotomía.

Palabras clave:
Mediastinoscopia
Estadificación clínica
Carcinoma de pulmón N2
Objective

To analyze the survival of patients undergoing lung resection for N2 bronchogenic carcinoma with negative findings at mediastinoscopy.

Material and method

Twenty-nine patients with N2 bronchogenic carcinoma were analyzed. The patients were taken from a series of 170 patients who underwent surgery between 1993 and 1997 and whose data were recorded by the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S). In 26 patients, nodes were found in the upper mediastinum; in three patients nodes were paraesophageal or in the area of the pulmonary ligament. In 11 cases, extracapsular nodal disease was found. Three patients who died in the postoperative period were excluded from survival analysis.

Results

The five-year survival rate for the series of 170 patients was 39%. For the 26 patients with N2 carcinoma, five-year survival was 14% (median 12 months). Five-year survival for the remaining patients (excluding those with N2 carcinoma) was 46%. Although the median survival of patients with intracapsular nodal disease was more than twice (25 months) that of patients with extracapsular nodal disease (12 months), the difference was not significant.

Conclusions

Lung resection in patients with N2 bronchogenic carcinoma with negative mediastinoscopy has little impact on survival. Surgical exploration of the mediastinum classifies such patients with greatest certainty, although the sensitivity of staging techniques warrants improvement to assure that thoracotomy is not used unnecessarily.

Key words:
Mediastinoscopy
Clinical staging
Lung cancer
N2
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