Original article
General thoracic
Nine-Year Single Center Experience With Cervical Mediastinoscopy: Complications and False Negative Rate

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
https://doi.org/10.1016/j.athoracsur.2006.05.023Get rights and content

Background

Mediastinoscopy is a valuable tool for evaluating mediastinal pathology and is essential for establishing treatment strategies in most patients with lung cancer. We sought to determine the complication and false negative rate for mediastinoscopy in an institution that routinely performs this procedure.

Methods

We performed a retrospective review of 2,145 consecutive mediastinoscopies at a single institution between April 1996 and April 2005. Demographics and complications were analyzed. In patients with lung cancer who underwent subsequent resection, the false negative rate was calculated.

Results

Mean patient age was 61 ± 0.4 years, and 58% (n = 1,253) were male. Pathology included lung cancer (n = 1,459), metastatic disease (n = 78), lymphoma (n = 51), and other benign disease (n = 557). Twenty-three patients (1.07%) experienced complications including hemorrhage (n = 7, 0.33%), vocal cord dysfunction (n = 12, 0.55%), tracheal injury (n = 2, 0.09%), and pneumothorax (n = 2, 0.09%). There was 1 death (0.05%) after pulmonary artery injury. Five of the 7 vascular injuries occurred during biopsy of level 4R. Three hundred and forty-three patients (23.5%) with lung cancer had positive mediastinoscopies. The false negative rate was 56 of 1,019 (5.5%) among lung cancer patients undergoing resection. Thirty-two (57%) of the false negatives were due to metastatic disease in lymph nodes not normally biopsied during cervical mediastinoscopy (levels 5, 6, 8, or 9).

Conclusions

Although invasive, mediastinoscopy identified locally advanced disease in a significant percentage of this lung cancer population and was associated with a low false negative rate. Complications after mediastinoscopy were uncommon. These results support the continued routine use of mediastinoscopy.

Section snippets

Patients and Methods

A retrospective review of a consecutive series of patients undergoing cervical mediastinoscopy between April 1996 and April 2005 was performed with approval and waiver of consent of the Institutional Review Board at Duke University Medical Center. This date range was chosen as it represents the era where dedicated general thoracic surgeons were available. For all patients with suspected lung cancer, mediastinoscopy was routinely performed (unless technically not feasible). Mediastinoscopy was

Results

Between April 1996 and April 2005, 2,145 patients underwent cervical mediastinoscopy for pathology evaluation of the mediastinum. Table 1 summarizes the patient demographics. Of the total patient population, 1,459 (68%) were diagnosed with either nonsmall-cell lung cancer (n = 1,399 or small-cell lung cancer (n = 60). Three hundred and forty-three patients (23.5%) with lung cancer were diagnosed with nodal metastasis to the mediastinum (nonsmall-cell lung cancer = 300, small-cell lung cancer =

Comment

Mediastinoscopy, during this 9-year period, was a safe tool for the diagnosis of mediastinal pathology. Both mortality and morbidity after cervical mediastinoscopy were fortunately uncommon, occurring 0.05% (1 of 2,145) and 1.07% (23 of 2,145) of the time, respectively. The most common complication was vocal cord dysfunction and was not life threatening. Just over half of the patients with new hoarseness required intervention in the form of vocal cord medialization, with the majority of these

References (25)

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