The importance of mediastinal lymph node invasion by pulmonary carcinoma in selection of patients for resection.

Resection results from 417 consecutive patients operated on between January 1, 1964, and December 30, 1969, were analyzed in March, 1976. This period was chosen to allow a five-year follow-up. The results of resection in 56 patients with invaded mediastinal nodes are reported. Mediastinoscopy to assess resectability was not used for any of the 417 patients. Our low incidence of mediastinal node invasion (56 out of 417, or 13.4%), a resectability rate of 97.4%, and a hospital mortality of 2.8% for resection of advanced carcinoma suggest that routine mediastinoscopy prior to resection is not necessary. Traditional methods of preoperative assessment and the use, when indicated, of extended resection for patients with mediastinal node invasion result in worthwhile salvage of patients with invaded mediastinal nodes.