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Quando operare???

Quando operare???. L. Toniolo Chir. Tor. CFVto. N0. N1. N2. Non chirurgico. N3. Non chirurgico !!!. Stadio IIIA (N2) Subsets. Metastasi “single station” identificate all’esame istologico definitivo (metastasi linfonodali microscopiche occulte). IIIA 1.

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Quando operare???

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  1. Quando operare??? L. Toniolo Chir. Tor. CFVto

  2. N0 N1

  3. N2 Non chirurgico

  4. N3 Non chirurgico !!!

  5. Stadio IIIA (N2) Subsets Metastasi “single station” identificate all’esame istologico definitivo (metastasi linfonodali microscopiche occulte) IIIA 1 Metastasi “single station” riconosciute intraoperatoriamente IIIA 2 N2 potenzialmente resecabile (identificato preoperatoriamente) IIIA 3 IIIA 4 N2 “bulky multistation” non resecabile

  6. Eterogeneità dell’ N2 • Single N2 disease significantly better survival than • multiple N2 disease • Tumor in the upper lobe significantly longer • survival than with middle/lower lobe involvement • Single N2 disease with NSCLC in the upper lobe • good candidates for pulmonary resection • (3- and 5-y survival 74,9% and 53,5%) Inoue M - J Thorac Cardiovasc Surg. 2004 Apr.; 127(4): 1100-6

  7. N2 sottocarenale Surgery for pts with T1-3 N2 NSCLC might be accettable if subcarinal lymph node metastasis is predicted to be absent Iwasaki A - J Thorac Cardiovasc Surg. 2006 Feb; 54(1): 42-6

  8. Skip phenomenon Adenoca T2 N0 M1 adenoca

  9. Stadio IIIA (N2) Subsets single-station metastases identified on the final pathological examination (occult microscopic nodal metastases) IIIA 1 single-station metastases recognized intraoperatively IIIA 2 potentially resectable N2 (identified preoperatively) IIIA 3 unresectable bulky multistation N2 disease IIIA 4

  10. pN – Linfonodi regionali pN0 Linfonodi liberi da malattia Metastasi ai linfonodi ilari, peribronchiali o intrapolmonari ipsilaterali pN1 pN2 Metastasi ai linfonodi mediastinici omolaterali Metastasi ai linfonodi controlaterali (ilari o mediastinici) o ai sovraclaveari pN3

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