title: Combined video-assisted mediastinoscopy and thoracoscopy in the management of lung cancer: a five-year experience.
abstract: OBJECTIVE
  The aim of this study was to assess the usefulness of combined video-assisted mediastinoscopy (VM) and video-assisted thoracoscopy (VT) in the management of patients with lung cancer.
  
  
  METHODS
  A prospective observational study was performed over a 5-year period. Indications for combined VM and VT included inconclusive findings from imaging techniques concerning locoregional extension and resectability; possible involvement of different structures not accessible to a single procedure; and failure to obtain a histologic diagnosis with a single technique.
  
  
  RESULTS
  An indication for combined exploration was established in 30 patients, representing 2.6% of all the patients referred to us for diagnosis, staging, and/or resection of lung cancer. Combined VM and VT was completed in 28 patients, as pleural carcinosis was found at VT in 2 cases. There was no mortality or morbidity in our series. Histologic diagnosis was obtained in 12/13 patients without preoperative histologic typing. In all the evaluated patients, combined VM and VT was useful in clinical decision-making, leading to immediate surgery (n=10), induction treatments (n=8), or nonsurgical therapy (n=12). Among the patients who underwent immediate surgery, combined VM and VT never failed to assess the T factor. The N factor was correctly evaluated in 8/10 patients, and in 2 patients it failed to recognize a minimal N2 disease.
  
  
  CONCLUSIONS
  Combined VM and VT is a safe and useful tool in the management of selected patients with lung neoplasms. Both the extent of primary tumor and the possible intrathoracic spread can be thoroughly evaluated.
authors.affiliation: Service de Chirurgie Thoracique, CHU de Nice, Hôpital Pasteur, Nice, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Mouroux
authors.forename: Nicolas
authors.initials: N
authors.lastname: Venissac
authors.forename: Marco
authors.initials: M
authors.lastname: Alifano
authors.forename: Francesco
authors.initials: F
authors.lastname: Leo
authors.forename: Michel
authors.initials: M
authors.lastname: Poudenx
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D020775:Thoracic Surgery, Video-Assisted; D013906:Thoracoscopy