The role of cervical mediastinoscopy in Nigerian thoracic surgical practice

Abstract

IntroductionCervical mediastinoscopy is the gold standard for obtaining histological diagnosis of mediastinal pathology. It has been used for the staging of lung cancer as well as to determine the cause of Isolated Mediastinal Lymphadenopathy. There is very limited evidence in the literature of its use in Nigeria to assess mediastinal pathology. The aim of this study was to describe our institutional experience with cervical mediastinoscopy.MethodsThis study was a retrospective analysis of 40 patients that underwent cervical mediastinoscopy in our institution between March 2007 and February 2013.ResultsThe indication for Cervical Mediastinoscopy was Isolated Mediastinal Lymphadenopathy in 24 patients (60%) and lung cancer staging in 16 patient (40%). The mean age of the patients was 52.7 + 15.1 years. There were 21 females (52.5%) and 19 males (47.5%). The most commonly biopsied lymph nodes were level 4 in 35 patients (87.5%) and level 7 in 21 patients (52.5%). Malignant diagnosis was made in 16 (66.7%) patients with Isolated Mediastinal Lymphadenopathy and in 13 (81.3%) patients staged for lung cancer. Hospital stay was less than 24 hours in all patients and there were no complications.ConclusionCervical Mediastinoscopy is available in Nigeria and has been performed in our institution with high diagnostic yield and no complications. Its increased use, along with the development of other mediastinal biopsy techniques is advocated to increase tissue biopsy of mediastinal pathology, especially for lung cancer and isolated mediastinal lymphadenopathy.

The challenges of cardiothoracic surgery practice in Nigeria: a 12 years institutional experience

“…In our series 223 patients (14.7%) presented with malignant pleural effusions and 32.6% of chest drain insertions were for malignant pleural effusions. There were no exploratory thoracotomies for lung cancer in our series as complete workup and staging is possible, including mediastinoscopy and flexible or rigid bronchoscopy (11,17).…”

“…Some procedures practiced in our institution are relatively novel among Nigerian institutions. We have developed a video-assisted thoracic surgery (VATS) practice (10) and mediastinoscopy practice (11). Unfortunately, further development of these practices revolves around appropriate referrals and limited affordability by patients.…”

“…General thoracic surgery, vascular surgery, closed heart surgery and OHS have all been established and practiced. Routine use of staplers, double lumen tubes for one lung ventilation, mediastinoscopy, and oesophageal stenting has been developed (11,34). Endoscopy for therapeutic and diagnostic purposes is available (17).…”

Cardiothoracic surgery training in Africa: History and developments

“… 17 , 18 Additionally, innovative techniques in surgery have begun to appear in a few countries, such as a robot-assisted surgery programs at Netcare Christiaan Barnard Memorial Hospital and video-assisted thoracic surgery and mediastinoscopy in Nigeria. 19 , 20 , 21 …”

“…Approximately 60% of surgeons are in the private sector, and many hold government part-time appointments. 18 , 21 Again, most centers are located in the main cities. A heart transplant program is performed in the state-owned University of Cape Town Health Services and some private cardiac centers in Cape Town and Johannesburg.…”