title: Video-assisted mediastinoscopic lymphadenectomy is associated with better survival than mediastinoscopy in patients with resected non-small cell lung cancer.
abstract: OBJECTIVE
  We aimed to analyze the accuracy of video-assisted mediastinoscopic lymphadenectomy (VAMLA) as a tool for preoperative staging and the impact of the technique on survival in patients with non-small cell lung cancer (NSCLC) undergoing pulmonary resection.
  
  
  METHODS
  Between May 2006 and December 2010, 433 patients underwent pulmonary resection for NSCLC, 89 (21%) had VAMLA before resection and 344 (79%) had standard mediastinoscopy. The patients who had negative VAMLA/mediastinoscopy results underwent anatomic pulmonary resection and systematic lymph node dissection.
  
  
  RESULTS
  The median and mean numbers of resected lymph node stations were 5 and 4.9 in the VAMLA group and 4 and 4.2 in the mediastinoscopy group (P = .9). The mean number of lymph nodes per biopsy specimen using standard mediastinoscopy was 10.1, whereas it was 30.4 using VAMLA (P < .001). VAMLA unveiled N2 or N3 disease in 30 (33.7%) and in 6 (6.7%) of patients, respectively. The negative predictive value, sensitivity, false-negative value, and accuracy of VAMLA were statistically higher in the VAMLA groups compared with those of standard mediastinoscopy. The 5-year survival was 90% for VAMLA patients and 66% for mediastinoscopy patients (P = .01). By multivariable analysis, VAMLA was associated with better survival (odds ratio, 1.34; 95% confidence interval, 1.1-3.2; P = .02).
  
  
  CONCLUSIONS
  VAMLA was associated with improved survival in NSCLC patients who had resectional surgery.
authors.affiliation: Department of Thoracic Surgery, Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey. Electronic address: akif.turna@gmail.com.
authors.forename: Akif
authors.initials: A
authors.lastname: Turna
authors.forename: Ahmet
authors.initials: A
authors.lastname: Demirkaya
authors.forename: Serkan
authors.initials: S
authors.lastname: Ozkul
authors.forename: Buge
authors.initials: B
authors.lastname: Oz
authors.forename: Atilla
authors.initials: A
authors.lastname: Gurses
authors.forename: Kamil
authors.initials: K
authors.lastname: Kaynak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008481:Mediastinoscopy / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000009:adverse effects / Q000401:mortality; D055815:Young Adult
keywords: 10.2; 10.4; 13; NSCLC; TEMLA; VAMLA; non–small cell lung cancer; transcervical extended mediastinal lymphadenectomy; video-assisted mediastinoscopic lymphadenectomy