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Combined mediastinal node assessment by lymphadenectomy and intraoperative mediastinoscopy

^a Department of Respiratory Surgery, Kinan Hospital 46–70, Shinnjou, Tanabe-city, Wakayama 646-8588, Japan
^b Second Department of Surgery, Ehime University School of Medicine 454, Shitsukawa, Touon-city, Ehime 791-0295, Japan

*Corresponding author. Tel.: +81-0739-22-5000; fax: +81-0739-22-0925.

E-mail address: nnakano{at}kinan-hp.tanabe.wakayama.jp (N. Nakano).

The purpose of this study was to determine the importance of combined mediastinal node assessment by lymphadenectomy and intraoperative mediastinoscopy to patients with left lung cancer. Forty-one patients with left lung cancer were divided into a group of 13 and a group of 28: in the first group, the aortic arch was mobilized, while in the second group the aortic arch was not mobilized. The mediastinal nodes of both groups were then dissected and mediastinoscopes were inserted into the operation field with an approach through thoracotomy to biopsy each mediastinal node. We compared nodal pathological assessment in these two groups. In the group with mobilized aortic arches, pathological assessment of lymphadenectomy at Naruke's station 3 was 11/13 (85%) and combined with intraoperative mediastinoscopy was 12/13 (92%). In the group without mobilized aortic arches, pathological assessment of lymphadenectomy of station 3 was 14/28 (50%) and combined use of intraoperative mediastinoscopy significantly improved the diagnoses to 24/28 (86%) (P=0.004). Combined use of lymphadenectomy and intraoperative mediastinoscopy could improve the assessment of station 3 in left lung cancer without mobilizing aortic arch.

Key Words: Lung cancer; Lymphadenectomy; Mediastinoscopy; Thoracotomy; Staging