Dissection of the left paratracheal area is frequently missed during left side non-small cell lung cancer surgery

In a paper recently published in the Journal of Thoracic Disease (1), the authors report their experience in intraoperative mediastinal staging in patients with left side non-small cell lung cancer (NSCLC) tumours classified as clinical stage I. The authors present a nice video showing how to dissect the left paratracheal areas after sectioning the ligamentum arteriosum via video-assisted thoracoscopic surgery (VATS), with very low morbidity and excellent 5-year survival (over 80%) in pN2 cases. In the authors’ series, the overall rate of unexpected N2 disease is 36%(27/75); of those, 10 cases (13.3%) were found to have positive lymph nodes on what the authors call “zone 2”, including 2L, 4L and 7 areas.