Metastasis to bilateral mediastinal and cervical lymphnodes was noted in a 58 year old male four and a half years after left lower lobectomy of the lung with lymphnode dissection (R2a, P-T1N2M0) by posterolateral incision. This case was treated by dissection of the left cervical and bilateral mediastinal lymphnodes from left cervical and median sternal incisions. Metastasis to the right supraclavicular lymphnodes was noted 11 days after discharge, and additional right cervical dissection was performed with satisfactory results. These possible routes include the tracheobronchial lymphnodes and the carinal nodes, via the upper or anterior portion of the left main bronchus. The routes continue via the nodes surrounding the trachea and the right paratrachea to the cervical nodes. This case suggests the necessity of bilateral mediastinal dissection and the significance of cervical dissection in left lung cancer.