Does videomediastinoscopy with frozen sections improve mediastinal staging during video-assisted thoracic surgery pulmonary resections?
BACKGROUND
To assess if video-mediastinoscopy (VM) with frozen sections (FS) combined with a video-assisted thoracic surgery major pulmonary resection (VMPRS) is able to improve VATS mediastinal intraoperative staging.


METHODS
From June 2012 to March 2015 a total of 146 patients underwent VMPRS lymphadenectomy. NCCN guidelines were followed for pre-operative staging, including VM with FS in 27 patients (19%). Procedural time, dissected nodal stations, complications related to VM and VATS lymphadenectomy and definitive histology, were evaluated.


RESULTS
Operative time for VATS resection with VM (group 1) and VATS pulmonary resection alone (group 2) was 198±64vs.167±43 min (P=0.003). Mean/median numbers of dissected nodal stations were 4.93±1.1/5 (range, 4-8) in group 1 and 3.25±0.5/5 (range, 3-8) in group 2 (P<0.001). Group 1vs.group 2 right-sided lymphadenectomy (n=86) was performed at station 2R/4R in 18 (90%) and 46 (69.7%); at station 3a/3p in 14 (51.8%) and 22 (31%); at station 7 in 18 (90%) and 44 (66.7%); at station 8/9 in 11 (55%) and 24 (36.4%) respectively. On the left side (n=60) group 1vs.group 2 lymphadenectomy resulted at station 4 in 6 (85.7%) and 38 (71.7%); at station 5/6 in 6 (85.7%) and 26 (49%); at station 7 in 6 (85.7%) and 33 (62.3%), and at station 8/9 in 1 (14.3%) and 18 (34%). There were no early deaths and recurrent laryngeal nerve palsy occurred in 1 (0.8%) in group 2. Pathological upstaging (pN1; pN2) was found in 5 patients (17%) in group 1, and 13 (11%) in group 2 (P=0.23). About FS (n=29), formal paraffin histology resulted in 0% of both, false negative and false positive results.


CONCLUSIONS
Based on our experience, the combination "VM with FS followed by VMPRS in sequence", seems to be effective and offers an alternative approach to improve intraoperative mediastinal staging.
Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
Alessandro
A
Gonfiotti
Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
Stefano
S
Bongiolatti
Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
Domenico
D
Viggiano
Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
Sara
S
Borgianni
Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
Roberto
R
Borrelli
Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
Giorgia
G
Tancredi
Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
Massimo O
MO
Jaus
Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
Leonardo
L
Politi
Department of Experimental and Clinical Medicine, Section of Surgery, Histopathology and Molecular Pathology, University of Florence, Italy.
Camilla E
CE
Comin
Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy.
Luca
L
Voltolini
VATS-lobectomy; Videomediastinoscopy (VM); lung cancer; lymphadenectomy; major pulmonary resection; video-assisted thoracic surgery (VATS)