An evaluation of mediastinoscopy in the management of presumably operable bronchial carcinoma

Early detection of mediastinal spread of pulmonary carcinoma by mediastinoscopy

To the great disappointment of all concerned, too many operations performed for pulmonary carcinoma still prove to be exploratory thoracotomies or non-curative resections, in spite of careful preoperative investigations.

A follow-up study of 168 patients operated upon for pulmonary carcinoma clearly shows that such non-curative procedures yield very disappointing results.

To reduce this number of unnecessary and often harmful operations mediastinoscopy was introduced as an aid in detecting mediastinal spread of the tumour. It was thought that such knowledge would make preoperative assessment more accurate and so make easier the decision whether to operate.

Mediastinoscopy: a clinical evaluation of 400 consecutive cases

Mediastinoscopy was carried out in 400 cases, including 296 of bronchogenic carcinoma. At the time of presentation the new growth had already spread to involve the mediastinal lymph nodes in slightly more than 50% of these. The incidence of involvement was 76% in oat-cell and 35% in squamous-cell carcinoma. Non-resectability at thoracotomy was encountered in seven out of 120 patients. We advocate this procedure in every case of bronchogenic carcinoma which is considered operable on other counts. In patients in whom the mediastinal lymph nodes are invaded by growth we prefer radical radiotherapy to surgery, as the long-term survival of the two methods is comparable. This procedure may be the only source of positive histological proof of diagnosis, not only in carcinoma but in other types of intrathoracic disease. We believe that this procedure reduces the number of unnecessary exploratory thoracotomies.