More than 30% of extra-thoracic malignances give rise to pulmonary metastasis during the course of the disease, and approximately 20% of these cases feature metastases that are confined to the lungs. The lung is one of the most common sites of distant metastasis of solid tumors because the pulmonary arterial vascular bed is the first filter in the hematogenous route. However, further large-volume and multi-institutional studies are needed.

SLN identification might be an indicator of whether or not MLND should be performed during pulmonary metastasectomy. Lymph node metastasis was identified in 3 of the 22 patients (13.6%), and none of the 3 patients with N1 or N2 disease had false-negative SLNs. In all patients, the SLN could be detected, and the number of SLNs identified was 2.0 ± 1.15 (range, 1–5) per patient. The number of dissected lymph nodes per patient was 14.4 ± 8.69 (range, 5–36). Lobectomy was performed in 17 patients, and segmentectomy, in 5 patients. During the operation, the radioactivity of the lymph nodes (ex vivo) was counted with a handheld gamma probe after MLND. Radiotracer was administered at the peritumoral region before surgery or soon after initiating surgery. A total of 22 patients (16 men, 6 women age 63.3 ± 7.01 years) who were candidates for metastasectomy through segmentectomy or lobectomy with MLND owing to cancers metastatic to the lung were enrolled in this study. This is the first study to evaluate the feasibility of mediastinal lymph node dissection (MLND) based on sentinel lymph node (SLN) status during pulmonary metastasectomy.

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