Background: This study aims to examine the factors influencing prognosis and long-term survival outcomes in pathological single-station N2 (pN2a) patients undergoing surgical treatment for non-small cell lung cancer. Methods: Between January 2012 and June 2021, a total of 144 patients (125 males, 19 females; mean age: 60.5±8.4 years; range, 48 to 78 years) who underwent anatomical resection for non-small cell lung cancer and were identified with pN2a disease were retrospectively analyzed. Factors influencing prognosis were analyzed. Survival analysis was performed. Results: Forty-nine (34%) patients received neoadjuvant therapy and 87 (60.4%) patients underwent lobectomy. In terms of staging, 95 (66%) patients were classified as Stage 3A, while 49 (34%) patients were categorized as Stage 3B. Analysis of N2 subtypes revealed that 77 (53.5%) patients were classified as known N2, whereas 67 (46.5%) patients were identified as incidental. Histopathological evaluation revealed that 58 (40.3%) patients had adenocarcinoma, while 86 (59.7%) patients had non-adenocarcinoma histology. N2 disease was categorized as skip metastasis (pN0N2a) in 61 (42.4%) patients and non-skip metastasis (pN1N2a) in 83 (57.6%) patients. Adjuvant therapy was administered to 126 (87.5%) patients, with treatment modalities determined by the oncology clinics and patient characteristics. Among these, 46 (31.9%) patients received chemotherapy, 15 (10.4%) patients underwent radiotherapy, and 65 (45.1%) patients were treated with chemoradiotherapy. The five-year overall survival rate was 33.9% with a median duration of 37.1±5.0 months. The disease-free survival rate was 24.9% with a median duration of 18.2±2.3 months. Adenocarcinoma histology, non-skip N2 disease, lack of adjuvant therapy, and advanced age (>65 years) were found to be significant factors affecting the prognosis of pN2a disease. Conclusion: The findings of this study indicate that adenocarcinoma histology, advanced age, absence of adjuvant therapy, and the presence of pN1N2a are significant prognostic factors in pN2a patients undergoing curative resection for non-small cell lung cancer.

Background: This study aims to evaluate the long-term results of patients with non-small cell lung cancer who underwent pulmonary artery resection and reconstruction. Methods: Between January 2010 and January 2023, a total of 50 patients (47 males, 3 females; mean age: 60.5±8 years; range, 43 to 83 years) who underwent lobectomy and pulmonary artery resection and reconstruction due to invasion of the pulmonary artery were retrospectively analyzed. Partial resection was performed in 45 patients. Circular pulmonary artery resection was performed in the remaining five patients. Demographic data of the patients, histopathology, lymph node metastasis, tumor size, T status, stage, comorbidity, neoadjuvant treatment and adjuvant treatment were recorded. Survival analysis was performed. Results: All patients were operated via thoracotomy. Except for those who underwent tangential resection with a stapler, the proximal and distal parts of the artery were resected by placing a Satinsky clamp. In 35 (70%) patients, pulmonary artery invasion originated from the tumor itself, while in 15 (30%) patients, it originated from the lymph node. The five-year survival rate was 46%, with an operative mortality rate of 6% and a morbidity rate of 24%. Cox regression analysis identified neoadjuvant treatment and N2 disease as statistically significant factors influencing survival. The median disease-free survival time for all patients was 27.9 (range, 4.5 to 51.2) months. Operated side, neoadjuvant treatment, N status, reason for pulmonary artery resection, sleeve resection and type of pulmonary artery resection showed statistically significant differences in the Kaplan-Meier analysis. Conclusion: Our study results suggest that pulmonary artery resections and reconstructions are feasible with acceptable morbidity and mortality rates. Neoadjuvant treatment, N2 disease, and the reason and type of pulmonary artery resection are potential factors influencing long-term survival. Pulmonary artery reconstruction is safe in experienced clinics with promising long-term survival outcomes.