Nicolas Venissac1, Daniel Pop, Jérôme Mouroux. 1. Thoracic Surgery Department, Pasteur Hospital, Building H1, 30 Avenue de la Voie Romaine, Nice, 06002, France.
Abstract
BACKGROUND: Video-assisted mediastinoscopy (VAM) is a well-known method for surgical exploration of superior retrovascular mediastinal disease and for determining the staging of lung cancer. This study aimed to report the authors' experience using VAM therapeutically. METHODS: Between 1998 and 2007, 765 patients had VAM in the authors' service. For 742 of these patients, VAM was used to diagnose or stage a disease. The remaining 23 patients (3%) had VAM as a therapeutic procedure. Two groups of patients were studied: those who had VAM alone and those who had VAM associated with another procedure. These studies focused on indications, results, and specific morbidity and mortality. RESULTS: The VAM alone group (14 patients) underwent mediastinal lymphadenectomy for thyroid cancer (mean number of lymph nodes/positives, 16/6) (n = 4), closure of the left post-pneumonectomy bronchopleural fistula (n = 3), mediastinal cyst resection (n = 5), ectopic hyperfunctioning parathyroid resection (n = 1), and mediastinal hematoma evacuation (n = 1). This group had an operative time of 40 to 160 min and a hospital stay of 2 to 10 days. The group that had VAM associated with another approach (9 patients) had VAM during transhiatal esophagectomy for cancer (mean number of lymph nodes, 8) (n = 7), VAM combined with video-assisted thoracoscopic surgery (n = 1), and minithoracotomy for masses in the aortopulmonary window (unique metastasis from melanoma or thyroid cancer) (n = 1). This group had an operative time of 60 to 135 min and a hospital stay of 7 to 52 days. No specific mortality or morbidity occurred. Meanwhile, three patients died: two after bronchopleural fistula (respiratory insufficiency, severe sepsis) and one because of liver insufficiency. Two patients experienced myocardial ischemia or pneumonia after transhiatal esophagectomy. CONCLUSIONS: "Exploratory" VAM for mediastinal disease is an important training tool that can be applied further for a therapeutic purpose. The authors' experience has shown its potential. Its surgical indications and benefits deserve better identification.
BACKGROUND: Video-assisted mediastinoscopy (VAM) is a well-known method for surgical exploration of superior retrovascular mediastinal disease and for determining the staging of lung cancer. This study aimed to report the authors' experience using VAM therapeutically. METHODS: Between 1998 and 2007, 765 patients had VAM in the authors' service. For 742 of these patients, VAM was used to diagnose or stage a disease. The remaining 23 patients (3%) had VAM as a therapeutic procedure. Two groups of patients were studied: those who had VAM alone and those who had VAM associated with another procedure. These studies focused on indications, results, and specific morbidity and mortality. RESULTS: The VAM alone group (14 patients) underwent mediastinal lymphadenectomy for thyroid cancer (mean number of lymph nodes/positives, 16/6) (n = 4), closure of the left post-pneumonectomy bronchopleural fistula (n = 3), mediastinal cyst resection (n = 5), ectopic hyperfunctioning parathyroid resection (n = 1), and mediastinal hematoma evacuation (n = 1). This group had an operative time of 40 to 160 min and a hospital stay of 2 to 10 days. The group that had VAM associated with another approach (9 patients) had VAM during transhiatal esophagectomy for cancer (mean number of lymph nodes, 8) (n = 7), VAM combined with video-assisted thoracoscopic surgery (n = 1), and minithoracotomy for masses in the aortopulmonary window (unique metastasis from melanoma or thyroid cancer) (n = 1). This group had an operative time of 60 to 135 min and a hospital stay of 7 to 52 days. No specific mortality or morbidity occurred. Meanwhile, three patients died: two after bronchopleural fistula (respiratory insufficiency, severe sepsis) and one because of liver insufficiency. Two patients experienced myocardial ischemia or pneumonia after transhiatal esophagectomy. CONCLUSIONS: "Exploratory" VAM for mediastinal disease is an important training tool that can be applied further for a therapeutic purpose. The authors' experience has shown its potential. Its surgical indications and benefits deserve better identification.