Value of Video-Assisted Mediastinal Lymphadenectomy in Mediastinal Staging in Non-Small-Cell Lung Cancer Patients

Mediastinal lymph node staging is essential in the management of patients with non-small-cell lung cancer. According to the guideline of the European Society of Thoracic Surgery, invasive staging should be performed in selected patients. The outcome of invasive staging with video-assisted mediastinoscopic lymphadenectomy in patients with potentially respectable non-small-cell lung cancer is evaluated in this study.

Patients who underwent invasive mediastinal staging by video-assisted mediastinoscopic lymphadenectomy between 2008 and 2019 received retrospective single-centre analysis. Patients were divided into 2 groups: one group met the guideline criteria for invasive staging, whereas the other group did not.

A total of 1640 patients were included in the study, 374 (22.8%) of whom had mediastinal lymph node metastases. N2 and N3 status were detected in 300 (18.2%) and 74 (4.5%) patients, respectively. The complication rate for the procedure was 4.8% (n = 79). False negative results were detected in 5 patients (2.2%). For the entire cohort, the sensitivity, specificity, negative predictive value, and accuracy were 98.68% (95% CI, 96.95%-99.57%), 100% (95% CI, 99.65%-100%), 99.53 (95% CI, 98.88%-99.8%), and 99.65% (95% CI, 99.19%-99.89%), respectively. In the guideline accordant-group, mediastinal metastases were detected in 370 out of 1463 cases (25.3%), whereas in the other-group, metastases were found in 4 out of 177 cases (2.3%), (P < .001).

Video-assisted mediastinoscopic lymphadenectomy is a safe procedure with high sensitivity, specificity, negative predictive value, and accuracy. The guideline criteria for selecting patients who should be considered for invasive mediastinal staging are valid.

Ethics committee of Medical Association Westphalia Lippe (2021-049-f-S).