Postinduction video-mediastinoscopy is as accurate and safe as video-mediastinoscopy in patients without pretreatment for potentially operable non–small cell lung cancer

Lardinois, Didier; Schallberger, Alex; Betticher, Daniel; Ris, Hans‐Beat

doi:10.1016/s0003-4975(02)04714-8

Cited by 62 publications

(32 citation statements)

References 23 publications

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“…Approximately 42%-57% of false-negative biopsies resulted in nodal stations that were not reached by cervical mediastinoscopy (stations 5, 6, 7 posteriorly and stations 8 and 9). The advantage of VAM is the improved visualisation of the operative field, leading to a higher accuracy and the possibility of teaching this technique without compromising the safety of the procedure [53,54]. An additional advantage is the clear removal of the subcarinal lymph node (station 7) and the safe visualisation of the oesophagus [55].…”

Section: Invasive Techniquesmentioning

confidence: 99%

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Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

Stamatis

2015

Eur Respir J

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Accurate staging and restaging of primary tumour and mediastinal nodes in patients with lung cancer is of significant importance. For primary tumours, computed tomography (CT) scans of the chest are recommended. Positron emission tomography (PET) imaging should be used in patients with curative intent treatment to evaluate metastatic disease. Diagnosis of the primary tumour should be performed using bronchoscopy or CT-guided transthoracic needle aspiration. In patients with enlarged mediastinal nodes and no distant metastasis, invasive staging of the mediastinum is required. For suspicious N2 or N3 disease, endoscopic needle techniques, such as endobronchial ultrasound and transbronchial needle aspiration, oesophageal ultrasound and fine needle aspiration, or a combination of both, are preferred to any surgical staging technique. In cases of suspicious nodes and negative results using needle aspiration techniques, invasive surgical staging using mediastinoscopy or video-assisted thoracic surgery should be performed. In central tumours or N1 nodes, preoperative invasive staging is indicated.Restaging after induction therapy remains a controversial topic. Today, neither CT, PET nor PET/CT scans are accurate enough to make final further therapeutic decisions for mediastinal nodal involvement. An invasive technique providing cytohistological information is still recommended.

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Section: Invasive Techniquesmentioning

confidence: 99%

“…Finally, the first cervical mediastinoscopy as a restaging procedure was reported by LARDINOIS et al [53]. In 195 patients without pretreatment and 24 patients after the completion of induction therapy, mediastinal lymph nodes were biopsied using a video-assisted approach.…”

Section: Diagnosis For Mediastinal Nodes (N-status)mentioning

confidence: 99%

Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

Stamatis

2015

Eur Respir J

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“…Patient selection was stringent and included only patients with resectable tumors without progression on CT scan after induction therapy. All patients had mediastinoscopically proven N2 disease [19]. Patients with N3 nodal involvement or with distant metastases were excluded.…”

Section: Commentmentioning

confidence: 99%

Comparison of neoadjuvant cisplatin-based chemotherapy versus radiochemotherapy followed by resection for stage III (N2) NSCLC

Pezzetta

Stupp

Zouhair

et al. 2005

European Journal of Cardio-Thoracic Surgery

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Objective: Comparison of prospectively treated patients with neoadjuvant cisplatin-based chemotherapy vs radiochemotherapy followed by resection for mediastinoscopically proven stage III N2 non-small cell lung cancer with respect to postoperative morbidity, pathological nodal downstaging, overall and disease-free survival, and site of recurrence. Methods: Eighty-two patients were enrolled between January 1994 to June 2003, 36 had cisplatin and doxetacel-based chemotherapy (group I) and 46 cisplatin-based radiochemotherapy up to 44 Gy (group II), either as sequential (25 patients) or concomitant (21 patients) treatment. All patients had evaluation of absence of distant metastases by bone scintigraphy, thoracoabdominal CT scan or PET scan, and brain MRI, and all underwent pre-induction mediastinoscopy, resection and mediastinal lymph node dissection by the same surgeon. Results: Group I and II comprised T1/2 tumors in 47 and 28%, T3 tumors in 45 and 41%, and T4 tumors in 8 and 31% of the patients, respectively (PZ0.03). There was a similar distribution of the extent of resection (lobectomy, sleeve lobectomy, left and right pneumonectomy) in both groups (PZ0.9). Group I and II revealed a postoperative 90-d mortality of 3 and 4% (PZ0.6), a R0-resection rate of 92 and 94% (PZ0.9), and a pathological mediastinal downstaging in 61 and 78% of the patients (P!0.01), respectively. 5y-overall survival and disease-free survival of all patients were 40 and 36%, respectively, without significant difference between T1-3 and T4 tumors. There was no significant difference in overall survival rate in either induction regimens, however, radiochemotherapy was associated with a longer disease-free survival than chemotherapy (PZ0.04). There was no significant difference between concurrent vs sequential radiochemotherapy with respect to postoperative morbidity, resectability, pathological nodal downstaging, survival and disease-free survival. Conclusions: Neoadjuvant cisplatin-based radiochemotherapy was associated with a similar postoperative mortality, an increased pathological nodal downstaging and a better disease-free survival as compared to cisplatin doxetacel-based chemotherapy in patients with stage III (N2) NSCLC although a higher number of T4 tumors were admitted to radiochemotherapy. Q

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“…procedure, although the mortality and morbidity associated with the procedure are very low17). Pre-and post-operative morbidity rates are generally listed as between 1 % and 5 % 2, 13,15,17,20). Structures at risk of injury with the procedure include the innominate artery, superior vena cava, azygous vein, pulmonary artery, esophagus, recurrent laryngeal nerves, and the aortic arch2, 15,17,20).…”

Section: Frozen Section Analysismentioning

confidence: 99%

“…Pre-and post-operative morbidity rates are generally listed as between 1 % and 5 % 2, 13,15,17,20). Structures at risk of injury with the procedure include the innominate artery, superior vena cava, azygous vein, pulmonary artery, esophagus, recurrent laryngeal nerves, and the aortic arch2, 15,17,20). Procedure-related complications have been reported ; these include recurrent nerve palsy, vascular lesion, esophagus injury, and wound infection 2,15,17,20) Yang reported that life-threatening injuries (hemorrhage, tracheal or esophageal tears) occur at a rate of 0.3%, major problems (recurrent laryngeal nerve palsy, pneumothrax) occur at 0.9%, and minor complications (wound infection or hematoma) occur at 0.8%2).…”

Section: Frozen Section Analysismentioning

confidence: 99%

Mediastinoscopy

Nonaka

Kataoka

Yamamoto

et al. 2003

The Showa University Journal of Medical Sciences

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Postinduction video-mediastinoscopy is as accurate and safe as video-mediastinoscopy in patients without pretreatment for potentially operable non–small cell lung cancer

Cited by 62 publications

References 23 publications

Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

Staging of lung cancer: the role of noninvasive, minimally invasive and invasive techniques

Comparison of neoadjuvant cisplatin-based chemotherapy versus radiochemotherapy followed by resection for stage III (N2) NSCLC

Mediastinoscopy

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