Intraoperative Staging and Surgical Management of Stage IIIA/N2 Non-Small Cell Lung Cancer

Thorough staging of the mediastinum is an integral component of the operative treatment of non-small-cell lung cancer. Systematic sampling and systematic lymph node dissection provide similar and accurate staging information; however, systematic lymph node dissection is more likely to identify multiple levels of N2 disease and may be associated with improved survival. Although every effort should be made to identify N2 disease before surgery, if intraoperative metastases to mediastinal lymph nodes are discovered, the planned operation should proceed. Cisplatin-based adjuvant chemotherapy has moderate but proven survival benefit after resection of N2 disease. The role of postoperative radiotherapy remains uncertain.