Subscribe to RSS
Quality Assessment of Video Mediastinoscopy Performed for Staging in Non-Small Cell Lung Cancer
10 March 2015
11 May 2015
28 July 2015 (online)
Background Mediastinoscopy is considered to be the gold standard for mediastinal staging for patients with non-small cell lung cancer (NSCLC). The diagnostic value depends on how this procedure is performed, which has resulted in drafting a guideline by the European Society of Thoracic Surgery (ESTS). Biopsy of at least stations 4R, 4L, 7, and if present stations 2R and 2L, is recommended. The objective of this study is to assess the quality of the mediastinoscopies performed in our hospital for NSCLC.
Methods Medical records of 102 consecutive patients with suspected or proven NSCLC and a performed cervical mediastinoscopy between January 2009 and November 2014 were analyzed in a retrospective cohort study. The number of biopsied stations and complications has been prospectively documented, together with their clinical data.
Results Cervical mediastinoscopy was performed in 102 patients and in 51 (50%) patients biopsy was taken of stations 4R, 4L, and 7. N2/N3 disease emerged more significantly (p < 0.05) if biopsies were taken of at least the paratracheal stations 4R/4L and the subcarinal region. The incidence of major complications was 3.9%.
Conclusion In our clinic, 50% of the mediastinoscopies performed are executed following the ESTS guidelines. Our results subscribe the need to biopsy at least the paratracheal stations 4L/4R and the subcarinal region to obtain a reliable assessment of the mediastinum.
- 1 De Leyn P, Lardinois D, Van Schil PE , et al. ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardiothorac Surg 2007; 32 (1) 1-8
- 2 Naruke T, Goya T, Tsuchiya R, Suemasu K. Prognosis and survival in resected lung carcinoma based on the new international staging system. J Thorac Cardiovasc Surg 1988; 96 (3) 440-447
- 3 Gunluoglu MZ, Melek H, Medetoglu B, Demir A, Kara HV, Dincer SI. The validity of preoperative lymph node staging guidelines of European Society of Thoracic Surgeons in non-small-cell lung cancer patients. Eur J Cardiothorac Surg 2011; 40 (2) 287-290
- 4 Sivrikoz CM, Ak I, Simsek FS, Döner E, Dündar E. Is mediastinoscopy still the gold standard to evaluate mediastinal lymph nodes in patients with non-small cell lung carcinoma?. Thorac Cardiovasc Surg 2012; 60 (2) 116-121
- 5 De Leyn P, Dooms C, Kuzdzal J , et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg 2014; 45 (5) 787-798
- 6 Verhagen AF, Schuurbiers OC, Looijen-Salamon MG, van der Heide SM, van Swieten HA, van der Heijden EH. Mediastinal staging in daily practice: endosonography, followed by cervical mediastinoscopy. Do we really need both?. Interact Cardiovasc Thorac Surg 2013; 17 (5) 823-828
- 7 De Leyn P, Dooms C, Kuzdzal J , et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg 2014; 45 (5) 787-798
- 8 van Albada ME, Eldering MJ, Post WJ, Klinkenberg TJ, Timens W, Groen HJ. The biopsying of at least 5 mediastinal lymph node stations for presurgical staging in patients with a non-small-cell lung carcinoma [in Dutch]. Ned Tijdschr Geneeskd 2004; 148 (6) 281-286
- 9 Tournoy KG, Keller SM, Annema JT. Mediastinal staging of lung cancer: novel concepts. Lancet Oncol 2012; 13 (5) e221-e229
- 10 Talsma AK, Veen HF, de Groot HGW, Veen EJ. Cervicale Mediastinoscopie. Ned Tijdschr Geneeskd 2010; 19 (8) 298-302
- 11 Goslings JC, Gouma DJ. What is a surgical complication?. World J Surg 2008; 32 (6) 952
- 12 Roukema JA, van der Werken C, Leenen LP. Registration of postoperative complications to improve the results of surgery [in Dutch]. Ned Tijdschr Geneeskd 1996; 140 (14) 781-784
- 13 Cho JH, Kim J, Kim K, Choi YS, Kim HK, Shim YM. A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy. Ann Thorac Surg 2011; 92 (3) 1007-1011
- 14 Zakkar M, Tan C, Hunt I. Is video mediastinoscopy a safer and more effective procedure than conventional mediastinoscopy?. Interact Cardiovasc Thorac Surg 2012; 14 (1) 81-84
- 15 Venissac N, Alifano M, Mouroux J. Video-assisted mediastinoscopy: experience from 240 consecutive cases. Ann Thorac Surg 2003; 76 (1) 208-212
- 16 Nelson E, Pape C, Jørgensen OD, Olsen KE, Licht PB. Mediastinal staging for lung cancer: the influence of biopsy volume. Eur J Cardiothorac Surg 2010; 37 (1) 26-29
- 17 Turna A, Demirkaya A, Ozkul S, Oz B, Gurses A, Kaynak K. Video-assisted mediastinoscopic lymphadenectomy is associated with better survival than mediastinoscopy in patients with resected non-small cell lung cancer. J Thorac Cardiovasc Surg 2013; 146 (4) 774-780
- 18 Sayar A, Citak N, Metin M , et al. Comparison of video-assisted mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy for lung cancer. Gen Thorac Cardiovasc Surg 2011; 59 (12) 793-798
- 19 Lemaire A, Nikolic I, Petersen T , et al. Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann Thorac Surg 2006; 82 (4) 1185-1189 , discussion 1189–1190
- 20 Hinterthaner M, Stamatis G. Role of mediastinoscopy and repeat mediastinoscopy today [in German]. Chirurg 2008; 79 (1) 38 , 40–44
- 21 Park BJ, Flores R, Downey RJ, Bains MS, Rusch VW. Management of major hemorrhage during mediastinoscopy. J Thorac Cardiovasc Surg 2003; 126 (3) 726-731
- 22 Zakkar M, Hunt I. Complication rates in mediastinoscopy and training: video versus conventional mediastinoscopy. Ann Thorac Surg 2012; 94 (1) 337 , author reply 337–338
- 23 Widström A. Palsy of the recurrent nerve following mediastinoscopy. Chest 1975; 67 (3) 365-366