Cervical mediastinoscopy and anterior mediastinotomy in patients with lung cancer and radiologically normal mediastinum.
In the period 1975-1980, 1504 patients presented with lung cancer, 291 were presumably operable, and had no radiological evidence of mediastinal lymph node invasion. Two thirds (192 patients) underwent pre-operative surgical mediastinal exploration, and one third (99 patients) were operated right away. Of the 162 cervical mediastinoscopies, 16% had lymph node invasion (19.7% with right-sided, 10.6% with left-sided tumor); 28.9% of the 45 left-anterior mediastinotomies were positive. There was only one positive cervical mediastinoscopy of 46 cases with lower-lobe tumor, and no positive anterior mediastinotomy in 5 cases with left lower-lobe tumor. Mediastinal exploration yields, thus, a relatively higher percentage of positive results if the cervical mediastinoscopy is restricted to tumors affecting the right upper and middle lobes (25%), and if the anterior mediastinotomy is restricted to the left upper lobe (32.5%). A left anterior mediastinotomy should, thus, be recommended instead of cervical mediastinoscopy for tumors of the left upper lobe.
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000556:secondary; D008481:Mediastinoscopy / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies