Clinical use of video-assisted mediastinoscopy in 　40 thoracic surgery patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Zhe , WU Qifei , ZHANG Guangjian , JIA Zhuoqi , LI Xinju , CHEN Jian ,  FU Junke

Department of Thoracic Surgery, the First Affiliated Hospital of Xi’an Jiaotong University Medical School, Xi’an, 710082, P.R.China;

Corresponding author：

FU Junke, Email: fujunk-6612@126.com

Keywords：

Mediastinoscopy; granulomatous mediastinitis; bronchial cystectomy

DOI：

10.7507/1007-4848.201704038

Video：

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Objective To evaluate the clinical role of video-assisted mediastinoscopy and its safety and effectiveness in the diagnosis of thoracic disease. Methods We reviewed the clinical data of consecutive 40 patients (25 males and 15 females with an average age of 54.6 years) who received video-assisted mediastinoscopic surgery in our department of thoracic surgery from December 2011 to November 2016, including mediastinal lymph node biopsy in 27 patients, mediastinal primary lesions biopsy in 8, bronchial cystectomy in 3 and esophageal dissection in 2. Results The histological results were positive in 20 patients (73.1%) in mediastinal lymph node biopsy, including granulomatous mediastinitis in 14 and metastasis in 6 (non-small cell lung cancer in 4, Ewing sacoma in 1 and small cell lung cancer in 1) and reactive proliferation in 7 (26.9%). In mediastinal primary lesions biopsy, the accuracy rate of diagnosis was 100.0%. The pathologic results were malignant in all patients, including small cell lung cancer in 5, adenoid cystic carcinoma in 1, squamous carcinoma in 1 and adenocarcinoma in 1. In patients who received the bronchial cystectomy, no recurrence was found during at least 2 years follow-up. There was one patient with severe complication (innominate artery injury). Two patients suffered transient laryngeal recurrent nerve palsy with hoarseness and two patients incision secretion. Conclusion Video-assisted mediastinoscopic surgery is effective and safe and dissection should be careful in granulomatous mediastinitis to avoid the great vessel injures.

Citation： WANG Zhe, WU Qifei, ZHANG Guangjian, JIA Zhuoqi, LI Xinju, CHEN Jian, FU Junke. Clinical use of video-assisted mediastinoscopy in 　40 thoracic surgery patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(12): 957-961. doi: 10.7507/1007-4848.201704038 Copy

1.	Carlens E. Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum. Dis Chest 1959, 36(4): 343-352.
2.	Annema JT, van Meerbeeck JP, Rintoul RC, et al. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA, 2010, 304(20): 2245-2252.
3.	傅尧箕. 纵隔镜检查术. 中华外科杂志, 1965, 13:760-761.
4.	王俊, 赵辉. 纵隔镜术及其在肺癌分期中的应用价值. 中华胸心血管外科杂志, 2002, 18(2): 190-192.
5.	Pearson FG, Delarue NC, Ilves R, et al. Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J Thorac Cardiov Sur, 1982, 83(1): 1-11.
6.	Rosell R, Gomez-Codina J, Camps C, et al. Preresectional chemotherapy in stage ⅢA non-small-cell lung cancer: a 7-year assessment of a randomized controlled trial. Lung cancer, 1999, 26(1): 7-14.
7.	De Leyn P, Dooms C, Kuzdzal J, et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2014, 45(5): 787-798.
8.	Bohm J, Boisdur L, Elze M, et al. Improved lymph node staging of lung cancer using EBUS-TBNA and liquid-based cytology: an alternative to mediastinoscopy? Onkologie, 2011, 34: 149.
9.	Ahmed-Nusrath A, Annamanneni R, Wyatt R, et al. Management of major hemorrhage during mediastinoscopy. J Cardiothor Vasc Anesth, 2006, 20(5): 762-763.
10.	Park BJ, Flores R, Downey RJ, et al. Management of major hemorrhage during mediastinoscopy. J Thorac Cardiov Sur, 2003, 126(3): 726-731.
11.	Alpay L, Lacin T, Kosar A, et al. Diagnostic algorithm in patients with superior vena cava syndrome and efficacy of cervical mediastinoscopy. Acta Chir Belg, 2014, 114(5): 309-312.
12.	Arslan E, Sanli M, Ulusan A, et al. Cervical mediastinoscopy: an alternative method for mediastinal cyst excision. Turk Gogus Kalp Dama, 2013, 21(3): 813-816.
13.	Pop D, Venissac N, Leo F, et al. Video-assisted mediastinoscopy: a useful technique for paratracheal mesothelial cysts. J Thorac Cardiovasc Surg, 2005, 129(3): 690-691.
14.	Zwishchenberger JB, Savage C, Alpard SK, et al. Mediastinal transthoracic needle and core lymph node biopsy: should it replace mediastinoscopy? Chest, 2002, 121(4): 1165-1170.
15.	Koide N, Takeuchi D, Suzuki A, et al. Mediastinoscopy-assisted esophagectomy for esophageal cancer in patients with serious comorbidities. Surg Today, 2012, 42(2): 127-134.
16.	Nomura T, Matsutani T, Hagiwara N, et al. Mediastinoscopy-assisted transhiatal esophagectomy for esophageal cancer: a single-institutional cohort study. Surg Laparo Endo Per, 2016, 26(6): E153-E156.
17.	徐正浪, 谭黎杰, 王群, 等. 影像监视经纵隔镜食管癌切除术 10 例报道. 上海医学大学学报, 1999, 26(3): 227-228.
18.	Li GS. Prof. Qingdong Cao: single-port inflatable mediastinoscopy combined with laparoscopy for the radical treatment of esophageal cancer. J Thoracic Dis, 2016, 8(9): E1108-E1109.
19.	Bulgen SB, Salihoglu Z, Demirkaya A, et al. A retrospective analysis of high-risk patients for mediastinoscopy. Turk Gogus Kalp Dama, 2013, 21(3): 699-705.

1. Carlens E. Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum. Dis Chest 1959, 36(4): 343-352.
2. Annema JT, van Meerbeeck JP, Rintoul RC, et al. Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA, 2010, 304(20): 2245-2252.
3. 傅尧箕. 纵隔镜检查术. 中华外科杂志, 1965, 13:760-761.
4. 王俊, 赵辉. 纵隔镜术及其在肺癌分期中的应用价值. 中华胸心血管外科杂志, 2002, 18(2): 190-192.
5. Pearson FG, Delarue NC, Ilves R, et al. Significance of positive superior mediastinal nodes identified at mediastinoscopy in patients with resectable cancer of the lung. J Thorac Cardiov Sur, 1982, 83(1): 1-11.
6. Rosell R, Gomez-Codina J, Camps C, et al. Preresectional chemotherapy in stage ⅢA non-small-cell lung cancer: a 7-year assessment of a randomized controlled trial. Lung cancer, 1999, 26(1): 7-14.
7. De Leyn P, Dooms C, Kuzdzal J, et al. Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2014, 45(5): 787-798.
8. Bohm J, Boisdur L, Elze M, et al. Improved lymph node staging of lung cancer using EBUS-TBNA and liquid-based cytology: an alternative to mediastinoscopy? Onkologie, 2011, 34: 149.
9. Ahmed-Nusrath A, Annamanneni R, Wyatt R, et al. Management of major hemorrhage during mediastinoscopy. J Cardiothor Vasc Anesth, 2006, 20(5): 762-763.
10. Park BJ, Flores R, Downey RJ, et al. Management of major hemorrhage during mediastinoscopy. J Thorac Cardiov Sur, 2003, 126(3): 726-731.
11. Alpay L, Lacin T, Kosar A, et al. Diagnostic algorithm in patients with superior vena cava syndrome and efficacy of cervical mediastinoscopy. Acta Chir Belg, 2014, 114(5): 309-312.
12. Arslan E, Sanli M, Ulusan A, et al. Cervical mediastinoscopy: an alternative method for mediastinal cyst excision. Turk Gogus Kalp Dama, 2013, 21(3): 813-816.
13. Pop D, Venissac N, Leo F, et al. Video-assisted mediastinoscopy: a useful technique for paratracheal mesothelial cysts. J Thorac Cardiovasc Surg, 2005, 129(3): 690-691.
14. Zwishchenberger JB, Savage C, Alpard SK, et al. Mediastinal transthoracic needle and core lymph node biopsy: should it replace mediastinoscopy? Chest, 2002, 121(4): 1165-1170.
15. Koide N, Takeuchi D, Suzuki A, et al. Mediastinoscopy-assisted esophagectomy for esophageal cancer in patients with serious comorbidities. Surg Today, 2012, 42(2): 127-134.
16. Nomura T, Matsutani T, Hagiwara N, et al. Mediastinoscopy-assisted transhiatal esophagectomy for esophageal cancer: a single-institutional cohort study. Surg Laparo Endo Per, 2016, 26(6): E153-E156.
17. 徐正浪, 谭黎杰, 王群, 等. 影像监视经纵隔镜食管癌切除术 10 例报道. 上海医学大学学报, 1999, 26(3): 227-228.
18. Li GS. Prof. Qingdong Cao: single-port inflatable mediastinoscopy combined with laparoscopy for the radical treatment of esophageal cancer. J Thoracic Dis, 2016, 8(9): E1108-E1109.
19. Bulgen SB, Salihoglu Z, Demirkaya A, et al. A retrospective analysis of high-risk patients for mediastinoscopy. Turk Gogus Kalp Dama, 2013, 21(3): 699-705.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical use of video-assisted mediastinoscopy in 　40 thoracic surgery patients

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical use of video-assisted mediastinoscopy in 40 thoracic surgery patients

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Clinical use of video-assisted mediastinoscopy in 　40 thoracic surgery patients