Complete mediastinal lymph node dissection versus systematic lymph node sampling in surgical treatment of non-small cell lung cancer: do we have the answer?

The question regarding the standard approach to mediastinal lymph nodes at time of pulmonary resection for non-small cell lung cancer has been discussed for several decades. Some argue that complete mediastinal lymph node dissection contributes to more accurate lymph node staging and survival benefit, whereas others believe that systematic mediastinal lymph node sampling is adequate for accurate staging and that formal dissection of the mediastinal nodes does not provide any survival advantage as patients with positive N2 nodes die from systemic disease.