Purpose: Treatment modalities for locally advanced small cell lung cancer IIIAN2 have long been a controversy issue.  Surgery after induction chemotherapy seems to be the most suitable choice for resectable tumors with a unique non bulkey mediastinal lymph node disease. Nethertheless, recent studies suggest that surgery first has the same results with less post-operative morbidity for a highly selected N2 subgroup.

Methodology: This was a retrospective study including all patients operated on for a lung cancer over a period extending from January 2015 to December 2021 in the thoracic surgery department of Abderrahmen MAMI hospital in Ariana and whose definitive histological examination of the surgical specimen concluded to a stage IIIA N2 NSCLC. Patients who underwent induction treatment and patients who underwent exploratory thoracotomy were excluded from this study.

Results: Thirty-six patients were enrolled. The average age was 63 years. The sex ratio was 6.2. A lobectomy was performed for 72% of the patients and a pneumonectomy for 14%. Median survival was 40 months. Tumor size, its histological type and its location in addition to the extent of ipsilateral mediastinal lymph node invasion had no impact on survival. The average survival was 51 months in men versus 19 months in women (p= 0.036). The average survival of patients who had a lobectomy was significantly better than in those who had a pneumonectomy (P=0.042).

Conclusion: Pneumonectomy should be avoided whenever possible by resorting to procedures sparing the pulmonary parenchyma such as bronchoplastic and angioplastic lobectomies for selected patients with N2 invasion.