Surgical Resection of Non–Small Cell Lung Cancer with N2 Disease

Mediastinal node involvement is the primary determinant for IIIA disease in NSCLC. It is locally advanced disease and curable, but remains a significant treatment challenge. There is no single treatment paradigm appropriate for all patients. The role for surgery is dictated by the ability to perform an R0 resection and by the extent of mediastinal node involvement. For most patients with N2 disease, induction therapy is recommended and survival is closely linked to the response to that treatment. Many believe that a trimodality approach using a combination of chemotherapy, radiation, and surgery provides the best hope for cure, but safety and success is highly dependent on careful patient selection and meticulous treatment delivery.