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Related Experiment Video

Updated: May 5, 2026

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Two-year survival and disease recurrence after endosonography with or without confirmatory mediastinoscopy for

Jelle E Bousema1, Louisa N Spaans1, Marcel G W Dijkgraaf2

  • 1Department of Surgery, Máxima MC, PO BOX 7777, 5500 MB Veldhoven, the Netherlands.

Lung Cancer (Amsterdam, Netherlands)
|March 27, 2025
PubMed
Summary
This summary is machine-generated.

Omitting mediastinoscopy after negative endosonography in resectable non-small cell lung cancer (NSCLC) did not impact survival or quality of life. This approach is safe for patients needing invasive mediastinal nodal staging.

Keywords:
Disease recurrenceEndosonographyLymph node dissectionMediastinal nodal stagingMediastinoscopyNon-small cell lung cancerOverall survivalQuality of lifeThoracic surgery

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Area of Science:

  • Oncology
  • Thoracic Surgery
  • Clinical Trials

Background:

  • Resectable non-small cell lung cancer (NSCLC) with high risk of mediastinal nodal involvement necessitates invasive staging.
  • Current guidelines often recommend mediastinoscopy for accurate nodal staging before surgery.

Purpose of the Study:

  • To evaluate the non-inferiority of omitting confirmatory mediastinoscopy after negative endosonography in patients with resectable NSCLC.
  • To assess the impact of this omission on overall survival (OS), disease-free survival (DFS), and health-related quality-of-life (HRQoL).

Main Methods:

  • The MEDIASTrial was a multicenter, non-inferiority trial.
  • Patients with resectable NSCLC and indication for invasive nodal staging were randomized.
  • Groups received either immediate resection or mediastinoscopy followed by resection.

Main Results:

  • Omitting mediastinoscopy resulted in a clinically negligible and non-inferior increase in unforeseen N2 disease.
  • Two-year OS and DFS were comparable between the immediate resection and mediastinoscopy groups.
  • Health-related quality-of-life scores remained similar across both groups during follow-up.

Conclusions:

  • Omission of confirmatory mediastinoscopy after negative endosonography is safe in resectable NSCLC.
  • This strategy does not negatively affect two-year survival outcomes or HRQoL.
  • This finding supports streamlining the staging process for selected NSCLC patients.