The Complete Hilar-Mediastinal Lymph Node Dissection

Abstract

Starting from Cahan’s “radical pneumonectomy” and “radical lobectomy”, mediastinal lymph node dissection was introduced in Japan by Ishikawa and survival results analyzed by Naruke. Japanese Lung Cancer Society (JLCS) introduced Naruke’s lymph node map to standardizing dissection. Upper mediastinum, subcarinal, interlobar and upper lobar lymph nodes are to be dissected for tumors located in the right upper lobe, and the same areas in the case of middle lobe. In tumors of the lower right lobe, also nodes of the lower mediastinum should be dissected. When the tumor is in the left upper lobe, upper mediastinum (except pre and paratracheal lymph nodes), subcarinal, interlobar and lobar nodes should be dissected. Finally, in left lower tumors, lower mediastinum is to be dissected. Super-radical dissection is performed through a median sternotomy to reach pre and paratracheal nodes in tumors affecting the left upper lobe.