From July 1992 through May 1993, 32 lung cancer patients underwent bilateral mediastinal lymph node dissection in conjunction with pulmonary resection via median sternotomy with or without thoracotomy. Operations were limited to clinically
negative
contralateral mediastinal lymph nodes metastasis. The locations of cancer were in the right upper lobe in 7 patients, right middle lobe in 2 patients, right lower lobe in 11 patients, loft upper lobe in 6 patients, and in loft lower lobe in 6
patients.
Histological diagnosis was epidermoid cell carcinoma in 12 patients, adenocarcinoma in 12 patients, bronchioloalveolar cell carcinoma in 3 patients, adenosquamous cell carcinoma in 2 patients, and one case each of small cell carcinoma, double
lung
cancer(adenocarcinoma and small cell carcinoma), and intraepithelial dysplasia after radiotherapy. Right pneumonectomy was performed in 10 patients, left pneumonectomy in 7 patients, right lower and middle lobectomy in 4 patients, right upper and
middle
lobectomy in 3 patients, left lower lobectomy in 4 patients, right upper lobectomy in 2 patients and left upper lobectomy in 2 patients.
Operative approaches were as follows; 21 cases of median sternotomy alone, 2 cases of median sternotomy with right posterolateral thoracotomy, 4 cases of median sternotomy with left anterolateral thoracotomy, 4 cases of median sternotomy with
left
posterolateral thoracotomy and 1 case of thoracoscopic left upper lobectomy and median sternotomy. Six patients(one patient with right upper lobe lesion and five patients with right lower lobe lesion) were proved to have contralateral mediastinal
lymph
node metastases which were not recognized preoperatively. There were 2 early postoperative deaths which were not related to the operation.
Median sternotomy in lung cancer surgery provide bilateral mediastinal lymph nodes dissection which is useful in postoperative staging and postoperative adjuvant therapy.
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