Skip to main content

Advertisement

SpringerLink
Log in

Comparison of video-assisted mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy for lung cancer

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

We compared the efficacy and complications of video-assisted mediastinoscopy (VAM) and video-assisted mediastinal lymphadenectomy (VAMLA) for mediastinal staging of lung cancer.

Methods

Between March 2006 and July 2008, a total of 157 patients with non-small-cell lung cancer (NSCLC) underwent VAM (n = 113, 72%) or VAMLA (n = 44, 28%). We studied them retrospectively. Data for the operating time, node stations sampled/dissected, number of biopsies, and the patients who were pN0 by mediastinoscopy and underwent thoracotomy were collected. The false-negative rate was calculated. Demographics and operative complications were analyzed.

Results

The overall complication rate was 5.7% (n = 9). The most common complication was hoarseness (n = 8). Complications were seen significantly more often after VAMLA than after VAM (11.3% vs. 2.6%, P = 0.04). There were no deaths. The mean number of removed lymph nodes (8.43 ± 1.08) and the station numbers (4.81 ± 0.44) per patient were higher with VAMLA than with VAM (7.65 ± 1.68, P = 0.008 and 4.38 ± 0.80, P = 0.001, respectively). The mean operating time was 44.8 ± 6.6 min for VAM and 82.0 ± 7.8 min for VAMLA. Patients diagnosed as pN2 numbered 9 in the VAMLA group and 27 in the VAM group. The patients diagnosed as pN0 with mediastinoscopy then underwent thoracotomy (VAM 77, VAMLA 32). When they were investigated for the presence of mediastinal lymph nodes, there were three (3.8%) false-negative results in the VAM group and five (15.6%) in the VAMLA group. Sensitivity, accuracy, and negative predictive values for VAM and VAMLA were 0.90/0.97/0.96 and 0.64/0.87/0.84, respectively.

Conclusion

VAMLA was found to be superior to VAM with regard to the number of stations and lymph nodes. Complications after VAMLA were common. The sensitivity and NPV of VAM for mediastinal staging are significantly higher than those of VAMLA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Carlens E. Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum. Dis Chest 1959;36: 343–352.

    PubMed  CAS  Google Scholar 

  2. Pearson FG. Mediastinoscopy: a method of biopsy in the superior mediastinum. J Thorac Cardiovasc Surg 1965;49:11–21.

    PubMed  CAS  Google Scholar 

  3. Melek H, Gunluoglu MZ, Demir A, Akin H, Olcmen A, Dincer SI. Role of positron emission tomography in mediastinal lymphatic staging of non-small cell lung cancer. Eur J Cardiothorac Surg 2008;33:294–299.

    Article  PubMed  Google Scholar 

  4. De Leyn P, Lardinois D, Van Schil PE, Rami-Porta R, Passlick B, Zielinski M, et al. ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardiothorac Surg 2007;32:1–8.

    Article  PubMed  Google Scholar 

  5. Detterbeck FC, Jantz MA, Wallace M, Vansteenkiste J, Silvestri GA. Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007;132:202S–202S.

    Article  PubMed  Google Scholar 

  6. Hurtgen M, Friedel G, Toomes H, Fritz P. Radical video-assisted mediastinoscopic lymphadenectomy (VAMLA): technique and first results. Eur J Cardiothorac Surg 2002;21:348–351.

    Article  PubMed  Google Scholar 

  7. Witte B, Wolf M, Hürtgen M, Toomes H. Video-assisted mediastinoscopic surgery: clinical feasibility and accuracy of mediastinal lymph node staging. Ann Thorac Surg 2006;82: 1821–1827.

    Article  PubMed  Google Scholar 

  8. Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997;111:1710.

    Article  PubMed  CAS  Google Scholar 

  9. Watanabe Y, Shimizu J, Oda M, Hayashi Y, Watanabe S, Tatsuzawa Y, et al. Aggressive surgical intervention in N2 non-small cell carcinoma of the lung. Ann Thorac Surg 1991; 51:253–261.

    Article  PubMed  CAS  Google Scholar 

  10. Leschber G, Holinka G, Linder A. Video-assisted mediastinoscopic lymphadenectomy (VAMLA): a method for systematic mediastinal lymph node dissection. Eur J Cardiothorac Surg 2003;24:192–195.

    Article  PubMed  Google Scholar 

  11. Leschber G, Sperling D, Klemm W, Merk J. Does videomediastinoscopy improve the results of conventional mediastinoscopy? Eur J Cardiothorac Surg 2008;33:289–293.

    Article  PubMed  Google Scholar 

  12. Toomes H. Mediastinoskopie. In: Nolte D, editor. Manuale pneumologicum. München-Deisenhofen: Dustri-Verlag Dr. Karl Feistle; 2000. p. 1–6.

    Google Scholar 

  13. Widstrom A. Palsy of the recurrent nerve following mediastinoscopy. Chest 1975;67:365–366.

    Article  PubMed  CAS  Google Scholar 

  14. Puhakka HJ. Complications of mediastinoscopy. J Laryngol Otol 1989;103:312–315.

    Article  PubMed  CAS  Google Scholar 

  15. Witte B, Hürtgen M. Video-assisted mediastinoscopic lymphadenectomy (VAMLA). J Thorac Oncol 2007;2:367–369.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Necati Çitak

    Present address: , Belgrad kapı Yolu No. 1 Zeytinburnu, İstanbul, 34020, Türkiye

Authors and Affiliations

  1. Thoracic Surgery Department, Yedikule Thoracic Surgery and Chest Disease Teaching and Research Hospital, Istanbul, Turkey

    Adnan Sayar, Necati Çitak, Muzaffer Metin, Akif Turna, Atilla Pekçolaklar, Abdulaziz Kök & Alper Çelikten

  2. Pathology Department, Yedikule Thoracic Surgery and Chest Disease Teaching and Research Hospital, Istanbul, Turkey

    Nur Ürer

  3. Anesthesiology and Reanimation Department, Yedikule Thoracic Surgery and Chest Disease Teaching and Research Hospital, Istanbul, Turkey

    Zeynep Nilgün Ulukol

Authors
  1. Adnan Sayar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Necati Çitak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muzaffer Metin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akif Turna
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atilla Pekçolaklar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abdulaziz Kök
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nur Ürer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alper Çelikten
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zeynep Nilgün Ulukol
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Necati Çitak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sayar, A., Çitak, N., Metin, M. et al. Comparison of video-assisted mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy for lung cancer. Gen Thorac Cardiovasc Surg 59, 793–798 (2011). https://doi.org/10.1007/s11748-011-0819-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-011-0819-8

Key words

Search

Navigation