Quando operare???

L. TonioloChir. Tor. CFVto

N0 N1

N2

Non chirurgico

N3

Non chirurgico !!!

Stadio IIIA (N2) Subsets

IIIA 1

IIIA 4

IIIA 2

IIIA 3

Metastasi “single station” identificate all’esame istologico definitivo (metastasi linfonodali microscopiche occulte)

Metastasi “single station” riconosciute intraoperatoriamente

N2 potenzialmente resecabile(identificato preoperatoriamente)

N2 “bulky multistation” non resecabile

Eterogeneità dell’ N2

Single N2 disease significantly better survival than multiple N2 disease

Tumor in the upper lobe significantly longer survival than with middle/lower lobe involvement

Single N2 disease with NSCLC in the upper lobe good candidates for pulmonary resection (3- and 5-y survival 74,9% and 53,5%)

Inoue M - J Thorac Cardiovasc Surg. 2004 Apr.; 127(4): 1100-6

N2 sottocarenale

Surgery for pts with T1-3 N2 NSCLC might be accettable if subcarinal lymph node metastasis is predicted to be absent

Iwasaki A - J Thorac Cardiovasc Surg. 2006 Feb; 54(1): 42-6

Skip phenomenon

M1 adenoca Adenoca T2 N0

Stadio IIIA (N2) Subsets

IIIA 1

IIIA 4

IIIA 2

IIIA 3

single-station metastases identified on the final pathological examination (occult microscopic nodal metastases)

single-station metastases recognized intraoperatively

potentially resectable N2 (identified preoperatively)

unresectable bulky multistation N2 disease

pN – Linfonodi regionali

pN0

pN3

pN1

pN2

Linfonodi liberi da malattia

Metastasi ai linfonodi ilari, peribronchiali o intrapolmonari ipsilaterali

Metastasi ai linfonodi mediastinici omolaterali

Metastasi ai linfonodi controlaterali (ilario mediastinici) o ai sovraclaveari