Il problema della linfadenectomia nel trattamento chirurgico del cancro broncogeno

Abstract

Bronchogenic carcinoma is one of the tumors with the statistically most markedly rising incidence, at least in we s t e rn countries. For many years both the resectability and the long-term results have remained invariable due to the serious delay with which the disease is usually diagnosed..

In addition, the success of treatment appears to be closely c o r related with disease stage; in particular lymph node i n vo l vement has a major influence on the long-term s u rv i val following adequate treatment. As a consequence, a s t rong conviction has established itself in recent years, that radical re m oval of all mediastinal lymph node stations i p s i l a t e ral to the operated lung re p resents not only a n e c e s s a ry staging pro c e d u re, but also a useful measure to i m p rove the prognosis of these patients. Howe ve r, the re a l utility of radical lymphadenectomy is questioned by a number of groups: on the one hand the supporters of lymph node “s a m p l i n g”, inasmuch as the usefulness of ra d i c a l lymphadenectomy has not been demonstrated by ra n d o m i zed clinical trials; on the other hand those work e r s , in particular from Japan, who on the basis of observa t i o n s of the lymphatic flow in the mediastinum stress the necessity to extend lymph node clearance to the nodal station contralate ral to the tumor. The current opinion is changing under the influence of recent developments, for istance the possible use of the sentinel technique also in lung cancer, and the possibility of “re a s o n a b l e” or targeted lymphadenectomies, planned in relation to the lobar location of individual tumor. Whichever of these appro a c h e s is chosen – and this choice is still a matter of debate – many agree about the importance of neoadjuvant tre a t m e n t not only to render patients eligible for surgery but also to i m p rove the prognosis for patients at the mosta adva n c e d stages of the disease.