Mediastinoscopy in superior vena cava obstruction: analysis of 80 consecutive patients.
BACKGROUND
Prejudices against mediastinoscopy in superior vena cava obstruction still remain. Hereby we analyze risk/benefit balance in a large series of patients.


METHODS
Eighty consecutive patients underwent cervical mediastinoscopy for caval obstruction, 51 after uncertain diagnosis obtained by lesser techniques, 17 after ineffective chemotherapy (n = 9) or radiotherapy (n = 8). In 12 patients we immediately performed mediastinoscopy as an urgent procedure. In addition the examination was combined with left anterior mediastinotomy (n = 7) for staging purposes.


RESULTS
No perioperative mortality was recorded. Five patients had significant bleeding, but only one required sternotomy. Definitive diagnosis was obtained in all patients: 50 lung cancer, 17 lymphoma, 7 invasive thymoma, 3 postradiation fibrosis, 2 metastatic lymph nodes from renal carcinoma, and 1 fibrosing mediastinitis. Specific therapy had excellent effects in 71 patients, negligible in 7, and adverse in 2. Postmediastinoscopy brachial venous pressure had a mean significant decrease (p < 0.0001). Lung cancer was the sole variable significantly associated with unfavorable outcome (p < 0.0004).


CONCLUSIONS
Mediastinoscopy should be routinely included after less invasive procedures in the diagnostic program because it is simple, low risk, and effective.
Mineo
T C
TC
Department of Thoracic Surgery, Tor Vergata University, Rome, Italy. mineo@utovrm.it
Ambrogi
V
V
Nofroni
I
I
Pistolese
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008481:Mediastinoscopy / Q000009:adverse effects; D008875:Middle Aged; D012189:Retrospective Studies; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis* / Q000209:etiology