Is routine mediastinoscopy indicated for patients with T1 non-small cell lung cancer?

Mediastinoscopy is gold standard in the staging patients with non-small cell lung cancer (NSCLC) patients. Yet, its necessity in every patient is being questioned as new data is being collected. In the present study, we compared pathology reports of the cases with T1 NSCLC both after mediastinoscopy and thoracotomy, and discussed about the necessity of mediastinoscopy.

We retrospectively reviewed the records of 74 patients (73 patients with pathologic T1 NSCLC patients who underwent pulmonary resection and one patient clinically T1 who did not undergo pulmonary resection), between 1996 and 2002. Clinically 80% of the cases were at T1 stage, and the rest were at T2 stage. The distribution of clinical lymph node status was NO in 85%, 15% N2.

Fifty-three (71.6%) cases underwent mediastinoscopy. Mediastinoscopy showed that one patient had contralateral lymph node involvement and the remaining cases had no lymph node metastases. No mortality occurred and morbidity rate was 1.9%. Lobectomy was performed in 60 cases, pneumonectomy in seven, wedge resection in five, and segmentectomy in one. The histopathologic types were; squamous cancer in 40 (55%) cases, adenocarcinoma in 29 (40%), and large cell carcinoma in four (5%). Only two cases (2.7%) who had no detectable lymph node metastases at mediastinoscopy were found to have N2 disease after thoracotomy. In rest of the cases, NO was observed in 48 (66%) and N1 in 23 (31.5%). Five-year survival of the cases was calculated to be 73%. The two cases with N2 disease are alive at seven and four years after the operation.

Routine mediastinoscopy does not appear to be necessary for patients with clinical T1 non-small cell carcinoma having no enlarged lymph nodes on computerised tomography.