Transcervical Extended Mediastinal Lymphadenectomy (TEMLA)

Abstract

Mediastinal lymph node staging is often the most important determinant of the long-term outcomes of surgical resection. In addition to determining the appropriateness of surgical resection, the “N” descriptor often determines the sequence of therapies in a multimodal treatment strategy. Historically, the gold standard for mediastinal lymph node staging was the cervical mediastinoscopy. Over the last decade, this procedure has been all but replaced with endobronchial ultrasound guided fine needle aspiration. However, an alternative direction to mediastinal staging has also evolved in the form of transcervical mediastinal lymph node dissections, either alone through a mediastinoscope (video assisted mediastinal lymphadenectomy) or combination of transcervical dissection and mediastinoscopy dissection (transcervical extended mediastinal lymph node dissection). This article describes the operative technique of transcervical extended mediastinal lymph node dissection, as well as indications and results.