J.Jpn. Surg. Soc.. 83(9): 983-988, 1982

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Report on the annual meeting

SUPERRADICAL OPERATION FOR CARCINOMA OF THE LEFT LUNG(N₂) THROUGH THE MEDIAN STERNOTOMY―ON THE BASIS OF VITAL BRONCHIAL LYMPHODRAINAGE OBTAINED BY LYMPHOSCINTIGRAPHY.

It is predicted that the reasonable lymphadenectomy contributes the postoperative survival rate of the patient with lung cancer, especially for the squamous cell carcinoma. After studying on the vital bronchial lymphodrainage in man with lymphoscintigraphy, we discussed about the systematic lymphadenectomy, its limit and its procedures.
In order to determine the normal lymphoscintigram, 198 lymph node scannings were carried out in 179 patients with neither hilar nor mediastinal lesions from May 1976 through March 1982. From our analysis of these lymphoscintigrams, standard patterns of regional lymphatic drainage were obtained.
The great part of lymph from each segmental bronchus in the right lung flows into the isolateral paratracheal lymph nodes. On the contrary,f rom the left lung, not only from the lower lobe, but from the upper lobe, lymph from each segmental bronchus mostly flows into the contralateral paratracheal lymph nodes. According to these results, we think it is necessary that the systematic lymphadenectomy, including the contralateral paratracheal lymph nodes, should be performed in cases of left lung cancer. Since October 1979, we have performed so called superradical operation through median-stemotomy for 10 cases with left lung cancer. The stages and operative procedures are the following ; 5 cases of Stage III, 2 cases of Stage II, 3 cases of Stage I, 6 pneumonectomies and 4 lobectomies. Only 1 case of T₃ died of brain metastases 6 months postoperatively. It is remarkable that 2 cases with N₂ are alive and disease free over 2 years.

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