Problems in Diagnosis and Surgical Management of Clinical N1 Non-small Cell Lung Cancer

In the staging process of cN1 disease, it will be helpful to perform mediastinoscopy and thoracoscopy to avoid unnecessary thoracotomy especially in adenocarcinoma, even though mediastinal nodes and pleural dissemination were negative on computed tomography investigation. Since extensive pulmonary resection (bilobectomy or pneumonectomy) was required in 41% of the patients, preoperative detailed cardiopulmonary function tests should be mandatory to reduce surgical morbidity and mortality. On the other hand, when pneumonia due to airway obstruction by the tumor exists, false-positive hilar nodes can be expected.