Should we operate on microscopic N2 XXXX ?

@entity1 @entity1149 @entity2
Traditionally @entity1149 ( @entity1149 ) stage N2 is considered as a contraindication for curative resection. We investigated the outcome of @entity1 with microscopic N2 disease, who underwent potentially curative resections. The independent effects of lobectomy vs. pneumonectomy, histology subtype, body mass index (BMI), sex, and PET-scanning were investigated. An N2 survival risk score was calculated and correlated with survival. Benchmarking revealed no discrepancies in our stage-specific survival data against the seventh edition of the International Association for the Study of @entity2 (IASLC) results. Of 1999 lung resections for primary @entity2 , 146 were pathologically staged as N2. @entity1 with resected microscopic N2 disease had a five-year survival equivalent to stage T3N1, P=0.39. Univariate analysis suggested pneumonectomy and T stage 3 as significant predictors of poor survival. Cox multivariate regression analysis revealed that age, BMI>30  kg/m(2), pneumonectomy, squamous type and positron emission tomography (PET)-scan all had a significant effect on survival, P<0.05. A low N2 survival risk score was associated with increased survival, P=0.001. Resecting microscopic N2 disease in @entity1149 may be appropriate in some @entity1 . An N2 survival scoring system may help select @entity1 for surgery, and help evaluate adjuvant and neoadjuvant publications with regard to microscopic N2 disease.
