Quando operare???
L. Toniolo
Chir. Tor. CFVto
N0
N1
N2
N3
Stadio IIIA (N2)
Subsets
IIIA 1
Metastasi “single station” identificate
all’esame istologico definitivo
(metastasi linfonodali microscopiche occulte)
IIIA 2
Metastasi “single station”
riconosciute intraoperatoriamente
IIIA 3
N2 potenzialmente resecabile
(identificato preoperatoriamente)
IIIA 4
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
single-station metastases identified
on the final pathological examination
(occult microscopic nodal metastases)
IIIA 2
single-station metastases
recognized intraoperatively
IIIA 3
potentially resectable N2
(identified preoperatively)
IIIA 4
unresectable bulky multistation
N2 disease
pN – Linfonodi regionali
pN0
Linfonodi liberi da malattia
pN1
Metastasi ai linfonodi ilari, peribronchiali
o intrapolmonari ipsilaterali
pN2
Metastasi ai linfonodi mediastinici
omolaterali
pN3
Metastasi ai linfonodi controlaterali (ilari
o mediastinici) o ai sovraclaveari