Mediastinal staging prior to surgical resection

Abstract

In our current conception of cancer, lymph nodes represent a pivotal transition between a primary tumor treated by surgical therapy alone and metastatic disease treated by an evolving combination of multimodality therapy. Invasive mediastinal staging provides an opportunity for preresectional histologic examination of these pivotal lymph nodes. The disadvantages of mediastinoscopy is that it requires general anesthesia and, in many cases, a delay in surgical resection. The advantages of mediastinoscopy are that it is safe and effective. In patients with suspected mediastinal lung cancer (stage III), mediastinoscopy provides lymph node staging and histologic confirmation of tumor type. In these selected patients, we perform sufficiently extensive mediastinal sampling that it is impractical to examine the entire specimen by frozen section. The price of a thorough examination of the lymph nodes is that the therapeutic resection may be delayed a week; nonetheless, the mediastinoscopy is low risk and can be performed as an outpatient procedure. In appropriately selected patients, invasive mediastinal staging provides important histologic information with minimal morbidity. © 2005 Elsevier Inc. All rights reserved.