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The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 53-56, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WP Luke, FG Pearson, TR Todd, GA Patterson and JD Cooper
Between 1979 and 1984, mediastinoscopy was performed on 1,000 of the 1,500
patients admitted to the Thoracic Surgical Service of the Toronto General
Hospital with the diagnosis of carcinoma of the lung. In 144 cases,
concomitant anterior mediastinoscopy was also performed. Abnormal
mediastinal nodes were found in 296 (29.6%). The overall complication rate
was 2.3%, with no deaths. Mediastinoscopy revealed diseased nodes in 24% of
patients with squamous cell carcinoma, 29% with adenocarcinoma, 54% with
small cell undifferentiated carcinoma, 31% with large cell undifferentiated
carcinoma, and 12% with bronchoalveolar carcinoma. Abnormal mediastinal
nodes were found with equal frequency in right- and left-sided tumors and
occurred in 31% of tumors in the main bronchus, 25% of upper lobe tumors,
and 17% of lower lobe tumors. Of the 704 patients having negative results
of mediastinoscopy, 590 were subjected to thoracotomy. Ninety-three percent
underwent resection (85% curative, 7% palliative) and 7% had unresectable
tumors. Of the resections, 20% were pneumonectomies. At thoracotomy, 52 of
the 590 patients with negative mediastinoscopic results were found to have
abnormal mediastinal nodes. Sixty-two of the 296 patients with positive
results of mediastinoscopy were selected for thoracotomy. Eighty-six
percent had resectable lesions (67% curative, 18% palliative) and 14%
unresectable. The pneumonectomy rate in this group was 35%. These current
data support our previous opinion that routine mediastinoscopy can be done
with negligible morbidity and provides essential information for the
classification and management of cancer of the lung.
ARTICLES
Prospective evaluation of mediastinoscopy for assessment of carcinoma of the lung
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