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Quando operare??? L. Toniolo Chir. Tor. CFVto. N0N1.

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Presentation on theme: "Quando operare??? L. Toniolo Chir. Tor. CFVto. N0N1."— Presentation transcript:

1 Quando operare??? L. Toniolo Chir. Tor. CFVto

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3 N0N1

4 N2 Non chirurgico

5 N3 Non chirurgico !!!

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8 Stadio IIIA (N2) Subsets IIIA 1 IIIA 4 IIIA 2 IIIA 3 Metastasi single station identificate allesame istologico definitivo (metastasi linfonodali microscopiche occulte) Metastasi single station riconosciute intraoperatoriamente N2 potenzialmente resecabile (identificato preoperatoriamente) N2 bulky multistation non resecabile

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10 Eterogeneità dell N2 Single N2 disease significantly better survival than multiple N2 disease Tumor in the upper lobe significantly longer survival than with middle/lower lobe involvement Single N2 disease with NSCLC in the upper lobe good candidates for pulmonary resection (3- and 5-y survival 74,9% and 53,5%) Inoue M - J Thorac Cardiovasc Surg Apr.; 127(4):

11 N2 sottocarenale Surgery for pts with T1-3 N2 NSCLC might be accettable if subcarinal lymph node metastasis is predicted to be absent Iwasaki A - J Thorac Cardiovasc Surg Feb; 54(1): 42-6

12 Skip phenomenon M1 adenoca Adenoca T2 N0

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14 Stadio IIIA (N2) Subsets IIIA 1 IIIA 4 IIIA 2 IIIA 3 single-station metastases identified on the final pathological examination (occult microscopic nodal metastases) single-station metastases recognized intraoperatively potentially resectable N2 (identified preoperatively) unresectable bulky multistation N2 disease

15 pN – Linfonodi regionali pN0 pN3 pN1 pN2 Linfonodi liberi da malattia Metastasi ai linfonodi ilari, peribronchiali o intrapolmonari ipsilaterali Metastasi ai linfonodi mediastinici omolaterali Metastasi ai linfonodi controlaterali (ilari o mediastinici) o ai sovraclaveari


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