Prevalence and prognostic value of mediastinal lymph node dissection in pulmonary metastasectomy : a retrospective single-center analysis

Abstract

Background: Pulmonary metastasectomy is an established part of the multimodal treatment of various malignant diseases. While the procedure typically focuses on complete removal of metastatic lesions, the role of mediastinal lymph node involvement remains unclear. We aimed to analyze the prevalence of lymph node involvement and its impact on prognosis in patients undergoing pulmonary metastasectomy.

Methods: Patients with different primaries with histologically confirmed pulmonary metastases that underwent pulmonary metastasectomy with the goal of complete resection were included in this retrospective analysis. The type of lymph node dissection, the type of lung resection, the number of lymph nodes harvested as well as survival data were analyzed.

Results: Among 219 patients, lymph node samples were obtained in 91 (41.6%). Lymph node metastases were identified in 13 patients (14.3%). No specific primary tumor entity showed a significantly higher risk of lymph node involvement. After a median follow-up of 10 months, 12 of 13 lymph node positive patients (92.3%) had either radiologically confirmed active disease or had died of malignancy, compared with 47.1% in the lymph node negative group (p = 0.013).

Conclusions: Mediastinal lymph node involvement in pulmonary metastasectomy is associated with poor prognosis and may occur across a broad spectrum of primary tumor entities. Our data may support the routine use of modern staging modalities such as PET/CT and EBUS in candidates for pulmonary metastasectomy, in order to better stratify patients and avoid unnecessary surgical interventions.