From anatomy to lung cancer: questioning lobe-specific mediastinal lymphadenectomy reliability

The prognosis of non-small cell lung cancer (NSCLC) is improving (1-3). The standard treatment of early-stage, mainly lobectomy with systematic complete hilar and mediastinal lymphadenectomy (MLND) (4), is questioned nowadays. Minimal surgery or still less aggressive procedures are being advocated and gaining preference due to emergence and development of new technologies. In fact, diagnosis of NSCLC in early-stage is more frequent and clinical-staging more precise, with the risk of overlooking lymph node (LN) involvement and distant metastasis becoming regularly smaller. Thus, surgeons are attempting to define the minimal and suitable extents of lung resection and LN-dissection, a technique concerning the latter being recently revisited in the review (5).