Early detection of mediastinal spread of pulmonary carcinoma by mediastinoscopy

Abstract

To the great disappointment of all concerned, too many operations performed for pulmonary carcinoma still prove to be exploratory thoracotomies or non-curative resections, in spite of careful preoperative investigations.A follow-up study of 168 patients operated upon for pulmonary carcinoma clearly shows that such non-curative procedures yield very disappointing results.To reduce this number of unnecessary and often harmful operations mediastinoscopy was introduced as an aid in detecting mediastinal spread of the tumour. It was thought that such knowledge would make preoperative assessment more accurate and so make easier the decision whether to operate.A comparison was made between two groups of patients-those who had and those who had no preoperative mediastinoscopy-to find out whether there was any difference in the postoperative results.The first group of patients consisted of all those operated on for pulmonary carcinoma between 1958 and 1962 in the Department of Thoracic Surgery, University of Groningen. None of the patients in this group had had a preoperative mediastinoscopy. The second group consisted of patients operated on between 1966 and 1969 when preoperative mediastinoscopy was routinely performed. The results of the follow-up study are presented in Tables I and II. It was found that 15 5% of all operations performed had to be regarded as exploratory thoracotomies. In these cases, the survival time never exceeded one year. Although our percentage of exploratory thoracotomies (15-5%) is significantly less than the 37% reported in Maassen's (1967) collective review, and although our mortality of two patients (7 8%) is below that

Mediastinoscopy in the surgical management of lung carcinoma.

“…This method, introduced by Carlens (1959), has been advocated for preoperative evaluation of patients with cancer of the lung by many European and American surgeons (Akovbiantz and Aeberhard, 1964;Girones, 1965;Maasen et al, 1965;Sarrazin and Voog, 1965;Jepsen, 1967;Bilgutay et al, 1969;Goldberg et al, 1970;Hajek and Homan van der Heide, 1970;Kirschner, 1971;Otto, Zaslonka, and Lukianski, 1972;Gibbons, 1972;Pearson et al, 1972). Sometimes 146 mediastinoscopy is replaced by anterior exploration of the mediastinum (mediastinotomy), as advocated by Chamberlain (1966), Stemmer et al (1965), Evans, Hall, andKent Harrison (1973), andJolly et al (1973).…”