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Ann Thorac Surg 1999;68:223-226
© 1999 The Society of Thoracic Surgeons

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Original Articles

Mediastinoscopy in superior vena cava obstruction: analysis of 80 consecutive patients

^a Department of Thoracic Surgery, Tor Vergata University, Rome, Italy

Address reprint requests to Dr Mineo, Cattedra di Chirurgia Toracica, Ospedale S. Eugenio, P.le Umanesimo 10, 00144 Rome, Italy;
e-mail: mineo{at}utovrm.it

Background. Prejudices against mediastinoscopy in superior vena cava obstruction still remain. Hereby we analyze risk/benefit balance in a large series of patients.

Methods. Eighty consecutive patients underwent cervical mediastinoscopy for caval obstruction, 51 after uncertain diagnosis obtained by lesser techniques, 17 after ineffective chemotherapy (n = 9) or radiotherapy (n = 8). In 12 patients we immediately performed mediastinoscopy as an urgent procedure. In addition the examination was combined with left anterior mediastinotomy (n = 7) for staging purposes.

Results. No perioperative mortality was recorded. Five patients had significant bleeding, but only one required sternotomy. Definitive diagnosis was obtained in all patients: 50 lung cancer, 17 lymphoma, 7 invasive thymoma, 3 postradiation fibrosis, 2 metastatic lymph nodes from renal carcinoma, and 1 fibrosing mediastinitis. Specific therapy had excellent effects in 71 patients, negligible in 7, and adverse in 2. Postmediastinoscopy brachial venous pressure had a mean significant decrease (p < 0.0001). Lung cancer was the sole variable significantly associated with unfavorable outcome (p < 0.0004).

Conclusions. Mediastinoscopy should be routinely included after less invasive procedures in the diagnostic program because it is simple, low risk, and effective.

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