Penetrating into the lymph nodes, tumor metastases are for a long time limited by the limits of the lymphatic reservoirs, regional for the affected lung lobe.
Spreading to the medistinal regions of the regional lymphatic collector, cancer metastases are stably and relatively long held on the side of the same name as the affected lung tumor. Therefore, the removal of lymph nodes and mediastinal tissue during surgical interventions only from the side of the corresponding lung fully complies with the principles of oncological radicalism. The transition of metastases to the opposite side of the mediastinum is usually
observed with total metastasis of the lymphatic collectors of the same name with a tumor in the lung. Then, metastasis in the retrograde direction — to the lymphatic bridles of the retroperitoneal region — often occurs.
A special place is occupied by the spread of lung cancer metastases from the mediastinal to the upstream lymphatic collectors.
Since the lymphatic collectors of the mediastinum and supraclavicular regions have numerous connections between each other, and the lymph flow in this region follows in an upward direction, metastasis of the tumor here is quite reasonable both anatomically and physiologically. It should be noted that the phasing of the spread of lymphogenous metastases to regional collectors always determines the position that, when blastomatous lesions of the lymph nodes of the supraclavicular collectors are established, it is possible to assert with complete certainty that the lower mediastinal groups of lymph nodes are involved in the pathological process. The general laws of lymphatic flow and cancer metastasis throughout the regional lymphatic lung collectors, as shown by studies in the clinic, make it possible to judge with a high degree of certainty the prevalence of the blastomatous process within the mediastinum, depending on various changes in the lymph nodes of the deep cervical lymphatic collectors .
With unilateral metastases in the supraclavicular lymph nodes on the side corresponding to the tumor affected by the lung, metastasis by this time always reaches the mediastinal collectors, it has a unilateral character. Moreover, the vastness of these changes may be greater or somewhat lesser, depending on whether a unilateral lesion of the supraclavicular lymph nodes is single or multiple.
With bilateral metastasis of cancer to the supraclavicular lymph nodes or unilateral, but contralateral with respect to the affected lung, changes in the mediastinal lymphatic collectors are always extensive. Then metastases here for a considerable extent block the pathways of lymph outflow along the collectors of the same side with the tumor affected by the tumor, and along the transverse connections they reach the lymph nodes of the opposite side of the mediastinum, making it impossible to perform surgical intervention in oncologically justified, practical limits.