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[Mediastinoscopy or thoracotomy? A prospective randomized study].

S Geroulanos, M Cadalbert, C Bosshard

    Helvetica Chirurgica Acta
    |October 1, 1977
    PubMed
    Summary
    This summary is machine-generated.

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    Mediastinoscopy before lung cancer surgery may improve short-term survival for high-risk patients but can reduce long-term resectability and 5-year survival rates.

    Area of Science:

    • Thoracic Surgery
    • Oncology
    • Diagnostic Procedures

    Background:

    • Bronchogenic carcinoma staging is crucial for treatment planning.
    • Mediastinoscopy is a diagnostic tool for assessing lymph node involvement.
    • The clinical utility of mediastinoscopy in operable lung cancer remains debated.

    Purpose of the Study:

    • To evaluate the impact of mediastinoscopy on surgical outcomes in patients with operable bronchogenic carcinoma.
    • To compare resectability, perioperative mortality, and survival rates between patients who underwent mediastinoscopy and those who did not.

    Main Methods:

    • Prospective, controlled, randomized trial involving 130 patients with clinically operable bronchogenic carcinoma.
    • Patients were divided into two groups: Group A (mediastinoscopy followed by thoracotomy) and Group B (direct thoracotomy).

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  • Follow-up was conducted for 5 years on 126 patients.

    • Main Results:

    • Curable resection rates were 56.4% in Group A versus 73.5% in Group B.
    • Perioperative mortality was 8% in Group A versus 16% in Group B.
    • Mean survival was better for patients with positive mediastinoscopy not undergoing thoracotomy (6.8 months) compared to direct thoracotomy (2.7 months), but 5-year survival was higher in Group B (10%) than Group A (16%).

    Conclusions:

    • Mediastinoscopy offers benefits for high-risk or inoperable lung cancer patients due to lower mortality and improved short-term survival.
    • However, it may decrease overall resectability and reduce the 5-year survival rate in operable cases.
    • The decision to use mediastinoscopy should consider individual patient risk factors and treatment goals.