title: Video-assisted mediastinoscopy in superior vena cava obstruction: to fear or not to fear?
abstract: BACKGROUND
  We investigate the safety and efficacy of video-assisted mediastinoscopy (VAM) used for diagnosis of the superior vena cava syndrome.
  
  
  METHODS
  In a 7-year period, we have done 447 VAM for malignant causes. We have compared, in a retrospective study from a prospectively maintained database, the differences between the groups with (first group) or without (second group) superior vena cava syndrome in terms of operative time, preoperative and postoperative complications, and results of pathologic examination. Statistical differences between the groups were calculated by χ2 test.
  
  
  RESULTS
  Mean operative time for first (31 patients) and second (416 patients) groups was 18 and 34 minutes, respectively (p < 0.00). Mean hospital stay was 1.2 days in both the groups. Mortality rates for the first and second groups were 0 and 0.5% (p = 0.31); major morbidity rates were 0 and 0.7% (p = 0.50); and minor morbidity rates were 6.4 and 1.7% (p = 0.27), respectively. In the superior vena cava syndrome group, most of the lymph nodes biopsied were in paratracheal superior sites (81%); histology showed small cell lung cancer in 51.6%, non-small cell lung cancer in 25.8%, and lymphoma in 22.6%.
  
  
  CONCLUSIONS
  VAM represents an important diagnostic tool in superior vena cava syndrome. Once decided to be used, we think that video technique is a good option with high rate of efficacy and low rates of mortality and morbidity.
authors.affiliation: Thoracic Surgery Department, Pasteur Hospital, Nice, France. danielpopch@yahoo.com
authors.forename: Daniel
authors.initials: D
authors.lastname: Pop
authors.forename: Nicolas
authors.initials: N
authors.lastname: Venissac
authors.forename: Ahmad S
authors.initials: AS
authors.lastname: Nadeemy
authors.forename: Patrice
authors.initials: P
authors.lastname: Guiraudet
authors.forename: Jérôme
authors.initials: J
authors.lastname: Mouroux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008207:Lymphatic Metastasis; D008223:Lymphoma / Q000150:complications*; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000150:complications*; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D020535:Video-Assisted Surgery; D055815:Young Adult