Mediastinal restaging with transcervical extended mediastinal lymphadenectomy in patients with locally advanced non-small cell lung cancer treated with pneumonectomy

Background: The purpose of this retrospective report was to assess long-term survival of patients with locally advanced non -small cell lung cancer (NSCLC) who underwent mediastinal restaging with transcervical extended mediastinal lymphadenectomy (TEMLA) after induction chemotherapy or chemoradiotherapy and then were treated with pneumonectomy. Methods: From January 2007 to December 2015, 68 NSCLC patients (52 men, 76.5%) underwent pneumonectomy after induction chemotherapy or chemoradiotherapy followed by negative surgical mediastinal restaging with TEMLA. Mean age was 59.4 years (47 to 75 years). There were 53 squamous cell carcinomas, 11 adenocarcinomas, 1 mixed carcinoma (adenocarcinoma-squamous cell) and 3 nonsmall cell lung carcinomas. Thirty-three patients (47%) were diagnosed with metastases to the mediastinal lymph nodes (LNs) before induction therapy. Neoadjuvant chemotherapy alone was given in 47 patients (69.1%) and chemoradiotherapy in 21 patients (30.9%). All patients were followed -up 60 months after pneumonectomy or until death. Results: There were no complications after TEMLA. Persistent metastatic N2 nodes were discovered in postpneumonectomy specimen in 4 patients after negative TEMLA (5.9%). There was no difference in overall 5 -year survival in patients with false negative TEMLA and in patients with true mediastinal downstaging (25% versus 40.6%). There were 32 right and 36 left pneumonectomies. Sixty-six patients had R0 resection and remaining 2 had R1 resection Overall 30 -day and 90 -day mortality after pneumonectomy was respectively 2.9% and 10.3%. Six patients developed bronchial stump fistula. Overall 5 -year survival after mediastinal restaging with TEMLA and subsequent pneumonectomy was 39.7%. and was similar in patients after right and left pneumonectomy (40.6% vs. 38.9%). Overall 5 -year survival was similar in patients who had mediastinal nodal metastases diagnosed before treatment and in patients who were not diagnosed with N2 disease (44.4% vs. 34.4%). Conclusions: TEMLA proved to be safe and effective in mediastinal restaging of locally advanced NSCLC. Precise selection of patients with good mediastinal response to neoadjuvant treatment may lead to satisfactory long-term outcomes after pneumonectomy.