[Mediastinoscopy in the evaluation of the extension of primary bronchial cancer. Techniques, indications and therapeutic deductions].
In order to achieve mediastinal lymph node staging in bronchial cancer, axial mediastinoscopy (combined with left anterior mediastinoscopy for cancers of the left upper lobe) is by far the most efficient and the most reliable technique. Since mediastinoscopy has been part of the investigations that can be made before thoracotomy, the number of exploratory thoracotomies has considerably decreased in all teams, thus reducing intraoperative mortality at the same time. Thoracic CT, which arrived in the diagnostic weaponry against lung cancer a long time after mediastinoscopy, has a major asset in that it allows selecting the patients for whom mediastinoscopy seems to be useful, on the basis of criteria related to the size of mediastinal lymph nodes (10 mm generally being the threshold chosen to perform mediastinoscopy or not). For almost all authors, systematic mediastinoscopy is no longer useful at present. Similarly, positive mediastinoscopic findings must not lead to systematically refuse patients, as the invasion or absence of invasion of a mediastinal lymph node is neither necessary nor sufficient to discuss a surgical indication. While some still automatically refuse all patients with positive mediastinoscopy, most authors still remain very interventionistic for N2 patients selected on the basis of very accurate criteria that are analyzed above, and surgery can then be performed at once or, for some authors, after a "neo-adjunctive" therapy, the long-term efficacy of which has unfortunately not been rigorously demonstrated as yet.
Levasseur
P
P
Service de Chirurgie Thoracique et Vasculaire de l'Hôpital Marie Lannelongue, Le Plesis-Robinson.
Regnard
J F
JF
Levi
J F
JF
D001984:Bronchial Neoplasms / Q000473:pathology*; D006801:Humans; D008207:Lymphatic Metastasis; D008481:Mediastinoscopy / Q000379:methods; D009367:Neoplasm Staging
La médiastinoscopie dans le bilan d'extension du cancer bronchique primitif. Techniques, indications et déductions thérapeutiques.