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Right arrow Lung - cancer

Ann Thorac Surg 2003;75:364-366
© 2003 The Society of Thoracic Surgeons

Original article: general thoracic

Mediastinoscopy in patients with clinical stage I non–small cell lung cancer

Yong Soo Choi, MDa, Young Mog Shim, MDa*, Jhingook Kim, MDa, Kwhanmien Kim, MDa

a Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

Accepted for publication September 5, 2002.

* Address reprint requests to Dr Shim, Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, 50 Ilwon Dong Kangnam Gu, Seoul, South Korea 135-710
e-mail: ymshim{at}smc.samsung.co.kr

BACKGROUND: The aim of this study was to investigate the significance of mediastinoscopy for clinical stage I non–small cell lung cancer.

METHODS: We reviewed 291 patients who underwent mediastinoscopy from January 1995 to December 2001 for clinical stage I non–small cell lung cancer. The patients who presented tumor-negative lymph nodes on mediastinoscopy underwent thoracotomy for pulmonary resection and mediastinal lymph node dissection in the same operative session. Mediastinoscopy-positive patients were referred for neoadjuvant therapy.

RESULTS: Of the 291 patients, 20 patients (6.9%) were found with N2 or N3 disease on mediastinoscopy. Among 271 mediastinoscopy-negative patients, thoracotomy-proven N0 was found in 201 patients (74.2%), N1 in 44 patients (16.2%), and N2 in 25 patients (9.2%). Seventeen of 25 patients with unforeseen N2 disease had positive lymph nodes in the station that could be approached by mediastinoscopy only. The positive rate of mediastinoscopy was significantly higher in the patients with nonbronchioloalveolar-type adenocarcinoma than in squamous cell carcinoma (11.5% vs 3.3%, p = 0.013). However, there was no difference in the mediastinoscopy-positive rate between clinical T1 and T2 status.

CONCLUSIONS: Though there are still controversies about routine mediastinoscopy in patients without mediastinal nodal enlargement on chest computed tomography scan, this study demonstrates that routine mediastinoscopy is necessary, especially for nonbronchioloalveolar-type adenocarcinoma patients.




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