An investigation into the lymphatic and vascular spread of carcinoma of the bronchus.

The present investigation was carried out because little work has been done to elucidate the problems concerning the lymphatic spread of bronchogenic carcinoma. The question, whether the treatment of carcinoma of the bronchus by lobectomy rather than by pneumonectomy is based on sound pathological principles, needed clarification. It was also felt that the establishment of a surgical-pathological classification for the purpose of prognosis and assessment of various forms of treatment, as has been donz for cancer at other sites, was long overdue. Furthermore, the anatomy of the intrapulmonary lymphatic pathways described in the past are no longer tenable in the light of our present knowledge of the bronchial and segmental anatomy of the lungs. Rouviere (1932), in his classic Anatomie des Lymphatiques de l'Homme, gives an excellent description of the mediastinal lymphatic pathways and nodes, but that of the interlobar and intrapulmonary nodes is inaccurate and his work does not divide the lymph flow into lobar or segmental distribution. Since that time few contributions have been made in this field; papers by McCort and Robbins (1951), Weinberg (1951), Borrie (1952), and that by Brock and Whytehead (1955) have touched on this subject. But all of these authors, with the exception of Borrie, reiterate, on the whole, Rouviere's statements on either the lymphatic anatomy or the drainage of the lungs.