Surgical exploration of the mediastinum: mediastinoscopy and intraoperative staging.
Lung resection remains the therapy of choice offering the greatest potential for cure in non-spread lung cancer. Prognostic importance of lymph-node involvement has been underlined by several studies. So, exploration of the mediastinum is of major importance for defining the therapeutic strategy in a possibly curative setting. Pre-resectional exploration of the mediastinal lymph-nodal status is mandatory to define tumour stage exactly and establish specific therapy. Cervical mediastinoscopy is the primary diagnostic procedure and remains the gold standard in invasive surgical staging. Complementary, parasternal mediastinoscopy, extended mediastinoscopy, and video-assisted thoracoscopy may be performed. These techniques allow accurate assessment of mediastinal lymph-node involvement, resulting in an appropriate judgement as to resectability and possible treatment options. Different techniques are established for intraoperative exploration and staging. In terms of curative surgery of lung cancer we demand accurate staging which is achieved by systematic and complete Lymph-node dissection. So, individually and dependent on primary tumour site, accurate mediastinal staging of Lung cancer should be performed in combination with definitive lung resection.
Semik
Michael
M
Dept. of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Albert-Schweitzer-Str. 33, D-48128 Münster, Germany. Michael.Semik@ukmuenster.de
Netz
Barbara
B
Schmidt
Christoph
C
Scheld
Hans Heinrich
HH
D006801:Humans; D007432:Intraoperative Period; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008481:Mediastinoscopy; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D020775:Thoracic Surgery, Video-Assisted