title: Mediastinoscopy and mediastinotomy after cardiac surgery: are safety and efficacy affected by prior sternotomy?
abstract: BACKGROUND
  The diagnostic and staging value of cervical mediastinoscopy is well established. Left anterior mediastinotomy is of further value in assessing left upper lobe tumors. However the efficacy and safety of both these procedures after median sternotomy for cardiac surgery is unknown.
  
  
  METHODS
  We undertook a retrospective review of our experience of mediastinal exploration by cervical mediastinoscopy with or without left anterior mediastinotomy in patients with prior sternotomy between 1980 and 2001.
  
  
  RESULTS
  During this period 28 patients (25 male and 3 female; mean age, 63 +/- 10 years), all with prior sternotomy for cardiac surgery (14 had left internal mammary artery graft), underwent mediastinal exploration. The mean interval between sternotomy and mediastinal exploration was 7.2 +/- 5.1 years. Additionally, 3 patients also had superior vena cava obstruction. Cervical mediastinoscopy was performed in all 28 patients and additionally left anterior mediastinotomy was undertaken in 7 of 28 patients (4 with left internal mammary artery graft). Indications for exploration were staging of lung cancer in 22 patients (cervical mediastinoscopy, n = 22; left anterior mediastinotomy, n = 7) and diagnostic biopsy of mediastinal mass in 6 patients (cervical mediastinoscopy, n = 6). Thorough mediastinal assessment was possible in all 28 patients. In the 22 patients with lung cancer the median number of lymph node stations sampled during mediastinoscopy was 3 (range, 1 to 5). A specific diagnosis was obtained in 16 patients (metastatic lung cancer, n = 10; lymphoma, n = 3; sarcoidosis, sinus histiocytosis, and metastatic melanoma, n = 1 each). The other 12 patients with negative findings underwent pulmonary resection and only 1 of 12 (8%) patients had unexpected N2 disease, a similar proportion to our overall experience with lung cancer. There were no operative complications.
  
  
  CONCLUSIONS
  Prior sternotomy for cardiac surgery does not compromise the efficacy and the safety of mediastinoscopy and mediastinotomy.
authors.affiliation: Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kumar
authors.forename: Katsuo
authors.initials: K
authors.lastname: Yamada
authors.forename: George P
authors.initials: GP
authors.lastname: Ladas
authors.forename: Peter
authors.initials: P
authors.lastname: Goldstraw
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008481:Mediastinoscopy; D008482:Mediastinum / Q000601:surgery*; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D013249:Sternum / Q000601:surgery*