Complications of Mediastinoscopy

Abstract

The purpose of this study is to report on complications experienced after 600 performed mediastinoscopies. Mediastinoscopy was indicated because of: 1. Suspicion of bronchial cancer: n = 292 (48.7%) ( = 48 (8%), d = 244 (40.7%), Suspicion of systemic disease: n = 248 (41.3%), Suspicion of mediastinal tumor: n = 33 (5.5%), Suspicion of metastases in lymph nodes caused by tumors of a different localisation, pleural process of unknown origin n = 27 (4.5%). Complications occurred in 3.7% of all cases; the most frequent of which were haemorrhage in 0.67% as well as paresis of the recurrent nerve in 1% which remained permanent in 0.33%. Furthermore, pneumothorax occurred in 0.8% of the cases, but had to be drained in one case only. Severe complications (eg death, bleeding, irreparable paresis of the recurrent nerve) occurred in 1.2% of all cases. We wish to mention a temporary elevation of the diaphragm on the right side, which can be looked upon as a complication rarely described in literature. We noted this in 1% of all cases and ascribe it to an irritation of the phrenic nerve.During the last two decades collar mediastinoscopy according to Carlens (1) developed into a superior bioptic procedure for evaluating the lymph nodes of the mediastinal zone (2-5). Indications, technique and efficiency of this method are well known in literature (6-16). Less attention has been paid to its side effects and complications (17-20) which form the basis of our report. Material and methodsThe following study presents the analysis of complications subsequent to 600 consecutively performed mediastinoscopies. Indications for mediastinoscopy were: Endoscopy 1 (1979) 9-12 Komplikationen bei der Mediastinoskopie Es wird über Komplikationen nach 600 konsekutiv durchgeführten Mediastinoskopien berichtet. Die Indikationen zu dieser Untersuchung vvaren: 1. Verdacht auf Bronchial-Ca: n = 292 (48,7%) ( = 48 (8%), c3' 244 (40,7%), 2. Verdacht auf Systemerkrankung: n = 248 (41,3%), 3. Verdacht auf Mediastinaltumor: n = 33 (5,5%), 4. Verdacht auf Lymphknotenmetastasen von Tumoren anderer Lokalisation, unklarer Pleuraprozeß: n = 27 (4,5%). Bei insgesamt 3,7% der Fälle traten Komplikationen auf. Die häufigsten Komplikationen waren die Blutung mit 0,67% sowie die Recurrensparese mit 1%, die in 0,33% bleibend war. Weiterhin trat in 0,8% ein Pneumothorax auf, der jedoch nur in einem Fall drainiert werden mußte. Schwere Komplikationen (Todesfall, Blutung, irreparable Recurrensparese) traten insgesamt in 1,2% auf. Es wird auf den rechtsseitigen, voriibergehenden Zwerchfellhochstand hingewiesen, eine in der Literatur ganz selten beschriebene Komplikation. Wir beobachten ihn in 1% der Falle und fiihren diese Komplikation auf eine Irritation des Nervus phrenicus zurück.

Clinical Value of Mediastinoscopy in the Diagnosis of Sarcoidosis: An Analysis of 68 Cases

“…The complications of mediastinoscopy are perioperative bleeding, pneumothorax, wound infection, and temporary recurrent nerve paresis. The rate for major complications with mediastinoscopy is between 0% and 1 % (average 0.5 %), the minor complication rate is between 1 % and 4.5 % (average 1.8 %), the mortality rate is 0.01 % [6,12,13,16]. The complication rate in our 68 cases turned out to be 0%.…”

“…In 66 cases (97 %) the diagnosis of sarcoidosis was confirmed. In previous studies, it was shown that the sensitivity and the specificity of mediastinoscopy for sarcoidosis was almost 100% [9,10,12,17]. The complications of mediastinoscopy are perioperative bleeding, pneumothorax, wound infection, and temporary recurrent nerve paresis.…”

Complications of mediastinoscopy

“…The reported incidences of mortality and morbidity with mediastinoscopy have been low, despite the fact that the procedure is performed in a region of the body with a high concentration of vital structures (Palva, 1964;Jepsen, 1966;Foster et al, 1972). In the earlier literature, a complication rate of between 1-3 per cent has been reported (Carlens and Hambraeus, 1967;Ross et al, 1970;Kliems and Savic, 1979). It is generally accepted that a patient must not be relegated to a lone, inexperienced operator for mediastinoscopy.…”

Pulmonary Sarcoidosis: Clinical Evaluation and Management

“…Despite its sensitivity, the procedure now rarely is required to establish the diagnosis of sarcoidosis, particularly because of the great sensitivity of bronchoscopy and because mediastinoscopy is less convenient, requires general anesthesia, and conveys a slightly greater risk than bronchoscopy. 96 An advantage of mediastinoscopy, however, is that the large amounts of tissue removed allow the pathologist to exclude malignancy or infection with somewhat greater certainty than permitted by examining the small pieces of tissue removed by transbronchial biopsy. Indications for mediastinoscopy in patients with suspected pulmonary sarcoidosis include failure to obtain granulomas by transbronchial biopsy and a clinical picture that raises more than the usual concern about possible lymphoma, carcinoma, or infection.…”