The value of video-assisted mediastinoscopy in pulmonary metastasectomy

To assess the role of video-assisted mediastinoscopy (VAM) in identifying involved mediastinal lymph nodes in patients undergoing pulmonary metastasectomy.

Over a 4-year period (2002-2005) a retrospective study was carried out in 57 patients (44 men, 13 women, mean age 59 years) undergoing isolated, unilateral or bilateral metastasectomy. Following staging CT scan, VAM was performed prior to open thoracotomy, median sternotomy or VATS resection of the metastasis. Follow-up was complete in all patients.

Fifty-seven patients underwent 62 operations for metastatic disease. The majority had colorectal cancer (39) followed by renal (11), sarcoma (9), liver (2) and miscellaneous (8). Six patients (10.5%) had positive mediastinal nodes on VAM. There was no perioperative morbidity or mortality. At a median follow-up of 25 months, 63 patients (68.5%) were still alive.

Mediastinal lymph node involvement has been reported to occur in up to 14% of patients with pulmonary metastasis. In our study, 10% of patients treated for pulmonary metastasis had positive nodal disease at metastasectomy. We believe our results confirm that VAM can be safely performed and may have a role in more accurate staging of metastatic disease and influence the decision for post-resection adjuvant therapy.