title: Video-Assisted Mediastinoscopic Lymphadenectomy for Staging Non-Small Cell Lung Cancer.
abstract: BACKGROUND
  The aim of this study was to evaluate the results of video-assisted mediastinoscopic lymphadenectomy (VAMLA) for staging of non-small cell lung cancer (NSCLC).
  
  
  METHODS
  This was a prospective observational study of all consecutive VAMLAs performed from January 2010 to April 2015 for staging NSCLC. For left lung cancers, extended cervical videomediastinoscopy was added to explore the subaortic and paraaortic nodes. Patients with negative VAMLA results underwent tumor resection and lymphadenectomy of the remaining nodes. Those with N2-3 disease underwent chemoradiation. The rate of unsuspected pathologic (p)N2-3 was analyzed in the global series and in the subgroups of patients according to their nodal status diagnosed by imaging and metabolic techniques.
  
  
  RESULTS
  One hundred sixty VAMLAs were performed for staging NSCLC (138 tumors were clinical (c)N0-1 based on imaging techniques). The rate of unsuspected N2-3 disease was 18% for the whole series: 40.7% for cN1, 22.2% for cN0 and tumor size greater than or equal to 3 cm, and 6.4% for cN0 and tumor size less than 3 cm. Staging values were sensitivity, 0.96 (95% confidence interval [CI], 0.81-99.3); specificity, 1 (95% CI, 0.97-1); positive predictive value, 1 (95% CI, 0.87-1); negative predictive value, 0.99 (95% CI, 0.95-0.99); and diagnostic accuracy, 0.99 (95% CI, 0.96-0.99). The complication rate was 5.9%.
  
  
  CONCLUSIONS
  VAMLA is a feasible and highly accurate technique. The high rate of unsuspected mediastinal node disease diagnosed by VAMLA in patients with cN1 or cN0 disease and tumor size larger than 3 cm suggests that preresection lymphadenectomies should be included in the current staging algorithms.
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain. Electronic address: 38641scc@comb.cat.
authors.forename: Sergi
authors.initials: S
authors.lastname: Call
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.
authors.forename: Carme
authors.initials: C
authors.lastname: Obiols
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Rami-Porta
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Trujillo-Reyes
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.
authors.forename: Manuela
authors.initials: M
authors.lastname: Iglesias
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.
authors.forename: Roser
authors.initials: R
authors.lastname: Saumench
authors.affiliation: Department of Pathology, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Gonzalez-Pont
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Serra-Mitjans
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Belda-Sanchís
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000628:therapy; D008197:Lymph Node Excision; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted