Quality Assessment of Video Mediastinoscopy Performed for Staging in Non-Small Cell Lung Cancer

Abstract

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.

Keywords

mediastinum - lung cancer - diagnosis - surgery - complications

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