[Combined cervical and left parasternal mediastinoscopy in tumors of the left upper lobe]

Since explorative thoracotomy and palliative resection do not in effect prolong life expectancy, it is essential to determine the operability of a lung tumour as accurately as possible. Cervical mediastinoscopy has considerably decreased the percentage of explorative thoracotomies. However, the lymph nodes in the periaortic region cannot be reached by cervical mediastinoscopy and these form an important lymph drainage pathway for the left upper lobe. The periaortic lymph nodes can be explored by left parasternal mediastinoscopy. In the present study, we investigated the value of combined cervical and parasternal mediastinoscopy in all patients with clinically operable central lung cancer of the left upper lobe, and in selected patients with a peripheral cancer of the left upper lobe. In the retrospective group, we found metastases at cervical mediastinoscopy in 23.4% of the patients with a tumour or the left lung and in 12.9% of the patients with a tumour of the left upper lobe. In the prospective group, we found metastases at cervical mediastinoscopy, possibly combined with parasternal mediastinoscopy, in 43% of the patients with a tumour of the left lung and in 41.9% of the patients with a tumour of the left upper lobe. All patients with positive mediastinoscopy involving either multiple nodes or an extranodal site, were excluded from operation. The number of explorative thoracotomies dropped in the prospective period and the resectability increased from 80.8% to 92.9% for the left lung and from 79.4% to 96.5% for the left upper lobe. These data indicate the reliability of parasternal mediastinoscopy in the assessment of the operability of left upper lobe lung cancer, in order to avoid unnecessary toracotomies and to avoid palliative resections.