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Gibson EA, Brust K, Steffey MA. Evaluation of mediastinoscopy for cranial mediastinal and tracheobronchial lymphadenectomy in canine cadavers. Vet Surg 2024; 53:834-843. [PMID: 38686899 DOI: 10.1111/vsu.14095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/17/2024] [Accepted: 03/23/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To report technical feasibility and describe procedural details of a novel single incision minimally invasive approach to the mediastinum in cadaver dogs. STUDY DESIGN Cadaveric study. ANIMALS Large breed (25-40 kg) cadaver dogs (n = 10). METHODS Three of 10 cadavers were used for preliminary technique development without data recording. Cadaver specimens underwent pre- and postoperative thoracic computed tomographic scans. Seven dogs were placed in dorsal recumbency and mediastinoscopy was performed via a SILS port placed cranial to the thoracic inlet with CO2 insufflation of the mediastinum at 2-4 mmHg. Retrieval of all CT and visually identified mediastinal lymph nodes (LN) was attempted; endoscopic compartmental and individual LN dissection times and subjective operative challenges were recorded. Procedural success scores for visualization and dissection as well as NASA-task force index scores were recorded per lymph node, per cadaver. RESULTS Median time required for initial approach including SILS placement was 5 min (range 5-10 min). Individual LN retrieval times ranged from 2 to 32 min. Mediastinoscopic retrieval of LNs was most commonly successful for the left tracheobronchial LN (7/7), followed by the right tracheobronchial LN (4/7), the left and right sternal LNs (3/7 each), and the cranial mediastinal LNs (1/7). Post-procedure pleural gas was identified on CT in 4/7 cadavers. CONCLUSIONS Mediastinoscopy as reported was feasible in large breed canine cadavers and retrieval or cup biopsy of a variety of lymph nodes is possible from the described approach. Application in living animals and its associated challenges should be further investigated. CLINICAL SIGNIFICANCE Mediastinoscopy may provide a novel minimally invasive approach to the evaluation and oncologic staging of the cranial mediastinum in dogs.
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Affiliation(s)
- Erin A Gibson
- William R. Prichard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Kelsey Brust
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
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2
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Öztürk A, Çiçek T, Yılmaz A. What is the yield of EBUS-TBNA for re-evaluation of previously treated non-small-cell lung cancer? Turk J Med Sci 2023; 53:586-593. [PMID: 37476873 PMCID: PMC10387873 DOI: 10.55730/1300-0144.5619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/13/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Locoregional recurrence in lung cancer still remains an important problem. We aimed to indicate the effectiveness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for reevaluation in previously treated nonsmall cell lung cancer (NSCLC). METHODS : NSCLC patients who underwent EBUS for rebiopsy of suspicious recurrent or progressive lesions between January 2010 and June 2017 were reviewed. Patients were categorized into two groups based on the previous treatment modalities: Group 1 (G1) consisted of patients who had been treated with chemoradiotherapy, and Group 2 (G2) consisted of patients who had undergone radical surgery. RESULTS Of 115 patients, 100 patients enrolled in the study. Of 26 patients with 35 lymph nodes in G1, malignant cells were identified in thirteen patients (50%). Anthracosis was detected in the remaining. Malignancy was detected in 28 patients (37.8%) in G2. Thirty-threepatients were diagnosed as benign (24 anthracosis; 8 lymphocytes, and 1 granulomatous); 8 were not sampled, and inadequate material was obtained in five. The sensitivity, specificity, negative and positive predictive value, and overall diagnostic accuracy of EBUS-TBNA for rebiopsy in G1 were 84.8%, 100%, 89.1%, 100%, and 93.2%, respectively. These values were all perfect in G2. DISCUSSION EBUS-TBNA could be preferred as a feasible and efficient procedure for rebiopsy in previously treated NSCLC patients.
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Affiliation(s)
- Ayperi Öztürk
- Department of Interventional Pulmonology, Atatürk Sanatoryum Training and Research Hospital, Health Science University, Ankara, Turkey
| | - Tuğba Çiçek
- Department of Chest Diseases, Konya Numune Hospital, Konya, Turkey
| | - Aydın Yılmaz
- Department of Interventional Pulmonology, Atatürk Sanatoryum Training and Research Hospital, Health Science University, Ankara, Turkey
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3
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Kawabata A, Nakamura T, Suzuki H, Yoshida M, Otsuki Y, Mori N. Coincidence of Sarcoidosis and a COVID-19 vaccine-associated hypermetabolic lymphadenopathy in a patient with a history of invasive breast cancer: A case report. Int J Surg Case Rep 2022; 94:107098. [PMID: 35464072 PMCID: PMC9017090 DOI: 10.1016/j.ijscr.2022.107098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 01/16/2023] Open
Abstract
Introduction and importance Vaccine-associated hypermetabolic lymphadenopathy (VAHL) after a COVID 19 vaccination is a common adverse event and also a diagnostic challenge especially in patients with a history of a malignancy. Case presentations A 47-year-old woman presented with enlarged lymph nodes in the right hilar, subcarinal, and right supraclavicular regions detected by computed tomography as a postoperative follow-up study of thyroid cancer. Fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) performed 3 weeks later revealed an FDG uptake in those swollen lymph nodes and in the novel lymphadenopathy in the left axilla and left subclavicular regions. Both biopsy specimens from the right supraclavicular and hilar lymph nodes revealed only multiple small granulomas with multinucleated giant cells without malignancy, consistent with sarcoidosis. The left axilla and subclavicular lymphadenopathy detected by the FDG-PET subsequently spontaneously regressed. Clinical discussion The coincidental occurrence of VAHL and lymphadenopathy in sarcoidosis patients could cause diagnostic confusion especially in those with breast cancer. Conclusion Sufficient attention should be paid both to the injection site and the time interval between the vaccination and imaging test in the era of nationwide mass vaccinations against COVID 19.
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Affiliation(s)
- Asuka Kawabata
- Department of Breast Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Toru Nakamura
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Hanae Suzuki
- Department of Breast Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Masayuki Yoshida
- Department of Breast Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Natsuko Mori
- Department of Breast Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka 430-8558, Japan.
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4
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Cowan J, Hutton M, Owen A, Lam D, Bracco D, Hurdle H, Lohser J, Hirshberg J, Cory J, Chow L, McDonald S, Haber J. Cognitive Aids for the Management of Thoracic Anesthesia Emergencies: Consensus Guidelines on Behalf of a Canadian Thoracic Taskforce. J Cardiothorac Vasc Anesth 2021; 36:2719-2726. [PMID: 34802832 DOI: 10.1053/j.jvca.2021.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/11/2022]
Abstract
A cognitive aid is a tool used to help people accurately and efficiently perform actions. Similarly themed cognitive aids may be collated into a manual to provide relevant information for a specific context (eg, operating room emergencies). Expert content and design are paramount to facilitate the utility of a cognitive aid, especially during a crisis when accessible memory may be limited and distractions may impair task completion. A cognitive aid does not represent a rigid approach to problem-solving or a replacement for decision-making. Successful cognitive aid implementation requires dedicated training, access, and culture integration. Here the authors present a set of evidence-based cognitive aids for thoracic anesthesia emergencies developed by a Canadian thoracic taskforce.
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Affiliation(s)
- Jayden Cowan
- Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada.
| | - Meredith Hutton
- Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Owen
- Department of Anesthesiology, McGill University. Montreal, Quebec, Canada
| | - Darren Lam
- Department of Anesthesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Bracco
- Department of Anesthesiology, McGill University. Montreal, Quebec, Canada
| | - Heather Hurdle
- Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jens Lohser
- Department of Anesthesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonah Hirshberg
- Department of Anesthesiology, University of Manitoba, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Julia Cory
- Department of Anesthesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lorraine Chow
- Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada
| | - Sarah McDonald
- Department of Anesthesiology, University of Toronto, Toronto, Ontario, Canada
| | - Julia Haber
- Department of Anesthesiology, University of Calgary, Calgary, Alberta, Canada
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Yazgan S, Ucvet A, Gursoy S, Ceylan KC, Yıldırım Ş. Surgical Experience of Video-Assisted Mediastinoscopy for Nonlung Cancer Diseases. Thorac Cardiovasc Surg 2020; 69:189-193. [PMID: 32634834 DOI: 10.1055/s-0040-1713138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Video-assisted mediastinoscopy (VAM) is a valuable method in the investigation of diseases with mediastinal lymphadenopathy or those localized in the mediastinum. The aim of this study was to determine the diagnostic value of VAM in the investigation of mediastinal involvement of nonlung cancer diseases and to describe our institutional surgical experience. METHODS Clinical parameters such as age, sex, histological diagnosis, morbidity, and mortality of all patients who underwent VAM for the investigation of mediastinal involvement of diseases except lung cancer between January 2006 and July 2018 were retrospectively reviewed, and the diagnostic efficacy of VAM was determined statistically. RESULTS During the study period, 388 patients underwent VAM, and 536 lymph nodes were sampled for histopathological evaluation of mediastinum due to mediastinal lymphadenopathy or paratracheal lesions. The most common diagnoses were sarcoidosis (n = 178 [45.9%]), tuberculous lymphadenitis (n = 108 [27.8%]), lymphadenitis with anthracosis (n = 72 [18.6%]), and lymphoma (n = 15 [3.9%]). CONCLUSION The results of the study show that VAM should be used because of its high diagnostic benefit in mediastinal lymphadenopathies, which are difficult to diagnose, or mediastinal lesions located in the paratracheal region. Despite the increase in the number of new diagnostic modalities, VAM is still the most effective method and a gold standard.
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Affiliation(s)
- Serkan Yazgan
- Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery Medical Practice Research Center, University of Health Sciences, Izmir, Turkey
| | - Ahmet Ucvet
- Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery Medical Practice Research Center, University of Health Sciences, Izmir, Turkey
| | - Soner Gursoy
- Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery Medical Practice Research Center, University of Health Sciences, Izmir, Turkey
| | - Kenan Can Ceylan
- Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery Medical Practice Research Center, University of Health Sciences, Izmir, Turkey
| | - Şener Yıldırım
- Department of Thoracic Surgery, Dr Suat Seren Chest Diseases and Surgery Medical Practice Research Center, University of Health Sciences, Izmir, Turkey
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Verdial FC, Berfield KS, Wood DE, Mulligan MS, Roth JA, Francis DO, Farjah F. Safety and Costs of Endobronchial Ultrasound-Guided Nodal Aspiration and Mediastinoscopy. Chest 2019; 157:686-693. [PMID: 31605700 DOI: 10.1016/j.chest.2019.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/03/2019] [Accepted: 09/12/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to detect differences in rare adverse events. We compared the risks and costs of endobronchial ultrasound (EBUS)-guided nodal aspiration and mediastinoscopy performed for any indication in a large national cohort. METHODS We conducted a retrospective study (2007-2015) with MarketScan, a claims database of individuals with employer-provided insurance in the United States. Patients who underwent multimodality mediastinal evaluation (n = 1,396) or same-day pulmonary resection (n = 2,130) were excluded. Regression models were used to evaluate associations between diagnostic modalities and risks and costs while adjusting for patient characteristics, year, concomitant bronchoscopic procedures, and lung cancer diagnosis. RESULTS Among 30,570 patients, 49% underwent EBUS. Severe adverse events-pneumothorax, hemothorax, airway/vascular injuries, or death-were rare and invariant between EBUS and mediastinoscopy (0.3% vs 0.4%; P = .189). The rate of vocal cord paralysis was lower for EBUS (1.4% vs 2.2%; P < .001). EBUS was associated with a lower adjusted risk of severe adverse events (OR, 0.42; 95% CI, 0.32-0.55) and vocal cord paralysis (OR, 0.57; 95% CI, 0.54-0.60). The mean cost of EBUS was $2,211 less than mediastinoscopy ($6,816 vs $9,023; P < .001). After adjustment this difference decreased to $1,650 (95% CI, $1,525-$1,776). CONCLUSIONS When performed as isolated procedures, EBUS is associated with lower risks and costs compared with mediastinoscopy. Future studies comparing the effectiveness of EBUS vs mediastinoscopy in the community at large will help determine which procedure is superior or if trade-offs exist.
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Affiliation(s)
- Francys C Verdial
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Kathleen S Berfield
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Douglas E Wood
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Michael S Mulligan
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Joshua A Roth
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - David O Francis
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Farhood Farjah
- Department of Surgery, University of Washington School of Medicine, Seattle, WA.
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7
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Novo M, Nowakowski GS, Habermann TM, Witzig TE, Micallef IN, Johnston PB, Inwards DJ, Botto B, Ristow KM, Young JR, Vitolo U, Ansell SM. Persistent mediastinal FDG uptake on PET-CT after frontline therapy for Hodgkin lymphoma: biopsy, treat or observe? Leuk Lymphoma 2019; 61:318-327. [DOI: 10.1080/10428194.2019.1663422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mattia Novo
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Torino, Italy
| | | | | | | | | | | | | | - Barbara Botto
- Division of Hematology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Torino, Italy
| | - Kay M. Ristow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Jason R. Young
- Division of Nuclear Medicine, Mayo Clinic, Rochester, MN, USA
| | - Umberto Vitolo
- Division of Hematology, Azienda Ospedaliera Universitaria Città Della Salute e Della Scienza di Torino, Torino, Italy
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Türktan M, Avcı A, Gezer S, Salih OK. Mediastinoskopi Girişimlerinde Kardiyopulmoner Bypass Gerektiren Damar Yaralanmalarında Anestezik Yaklaşım. DICLE MEDICAL JOURNAL 2019. [DOI: 10.5798/dicletip.620646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Santini M, Fiorelli A. Surgery: Recommendations for Surgeons. CURRENT CLINICAL PATHOLOGY 2018:43-64. [DOI: 10.1007/978-3-319-90368-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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10
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Anesthesia for Mediastinoscopy and Mediastinal Surgery. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Cata JP, Lasala J, Mena GE, Mehran JR. Anesthetic Considerations for Mediastinal Staging Procedures for Lung Cancer. J Cardiothorac Vasc Anesth 2017; 32:893-900. [PMID: 29174661 DOI: 10.1053/j.jvca.2017.08.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Indexed: 12/25/2022]
Abstract
Tumor staging is critical for the treatment of lung malignancies. Invasive techniques of lung tumor staging can be accomplished via mediastinoscopy, endobronchial ultrasound, and video-assisted thoracoscopy. Anesthesiologists taking care of patients undergoing mediastinal staging procedures might face different challenges. In this narrative review, the authors summarize the literature on the anesthetic considerations for mediastinal staging procedures.
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Affiliation(s)
- J P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Texas, USA.
| | - J Lasala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Texas, USA; Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - G E Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - J R Mehran
- Anesthesiology and Surgical Oncology Research Group, Houston, Texas, USA
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Falase B, Ogadinma M, Majekodunmi A, Nimasahun B, Adeyeye O. The role of cervical mediastinoscopy in Nigerian thoracic surgical practice. Pan Afr Med J 2016; 24:135. [PMID: 27642473 PMCID: PMC5012774 DOI: 10.11604/pamj.2016.24.135.7668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 03/29/2016] [Indexed: 12/25/2022] Open
Abstract
Introduction Cervical mediastinoscopy is the gold standard for obtaining histological diagnosis of mediastinal pathology. It has been used for the staging of lung cancer as well as to determine the cause of Isolated Mediastinal Lymphadenopathy. There is very limited evidence in the literature of its use in Nigeria to assess mediastinal pathology. The aim of this study was to describe our institutional experience with cervical mediastinoscopy. Methods This study was a retrospective analysis of 40 patients that underwent cervical mediastinoscopy in our institution between March 2007 and February 2013. Results The indication for Cervical Mediastinoscopy was Isolated Mediastinal Lymphadenopathy in 24 patients (60%) and lung cancer staging in 16 patient (40%). The mean age of the patients was 52.7 + 15.1 years. There were 21 females (52.5%) and 19 males (47.5%). The most commonly biopsied lymph nodes were level 4 in 35 patients (87.5%) and level 7 in 21 patients (52.5%). Malignant diagnosis was made in 16 (66.7%) patients with Isolated Mediastinal Lymphadenopathy and in 13 (81.3%) patients staged for lung cancer. Hospital stay was less than 24 hours in all patients and there were no complications. Conclusion Cervical Mediastinoscopy is available in Nigeria and has been performed in our institution with high diagnostic yield and no complications. Its increased use, along with the development of other mediastinal biopsy techniques is advocated to increase tissue biopsy of mediastinal pathology, especially for lung cancer and isolated mediastinal lymphadenopathy.
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Affiliation(s)
- Bode Falase
- Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Mgbajah Ogadinma
- Cardiothoracic Division, Department of Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Adetinuwe Majekodunmi
- Department of Anaesthesia, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Barakat Nimasahun
- Department of Paediatrics, Lagos State University College of Medicine, University Teaching Hospital, Lagos, Nigeria
| | - Olufunke Adeyeye
- Respiratory Unit, Department of Medicine, Lagos State University College of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
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Abstract
The potential for intraoperative bleeding is inherent to the practice of thoracic surgery due to the presence of multiple vital vascular structures, complex anatomy, and constant cardiorespiratory motion. Careful and detailed preoperative evaluation and planning, comprehensive review of imaging studies, and a thorough knowledge of the operative procedure, anatomic relationships, and potential complications are of the highest importance in prevention and avoidance of bleeding complications. Preparation with a clear crisis management plan ensures an effective and expedited response when intraoperative bleeding occurs.
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Affiliation(s)
- Manuel Villa
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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14
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Farjah F, Madtes DK, Wood DE, Flum DR, Zadworny ME, Waworuntu R, Hwang B, Mulligan MS. Vascular endothelial growth factor C complements the ability of positron emission tomography to predict nodal disease in lung cancer. J Thorac Cardiovasc Surg 2015; 150:796-803.e1-2. [PMID: 26320776 PMCID: PMC4889434 DOI: 10.1016/j.jtcvs.2015.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/01/2015] [Accepted: 08/02/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Vascular endothelial growth factors (VEGFs) C and D are biologically rational markers of nodal disease that could improve the accuracy of lung cancer staging. We hypothesized that these biomarkers would improve the ability of positron emission tomography (PET) to predict nodal disease among patients with suspected or confirmed non-small cell lung cancer (NSCLC). METHODS A cross-sectional study (2010-2013) was performed of patients prospectively enrolled in a lung nodule biorepository, staged by computed tomography (CT) and PET, and who underwent pathologic nodal evaluation. Enzyme-linked immunosorbent assay was used to measure biomarker levels in plasma from blood drawn before anesthesia. Likelihood ratio testing was used to compare the following logistic regression prediction models: ModelPET, ModelPET/VEGF-C, ModelPET/VEGF-D, and ModelPET/VEGF-C/VEGF-D. To account for 5 planned pairwise comparisons, P values <.01 were considered significant. RESULTS Among 62 patients (median age, 67 years; 48% men; 87% white; and 84% NSCLC), 58% had fluorodeoxyglucose uptake in hilar and/or mediastinal lymph nodes. The prevalence of pathologically confirmed lymph node metastases was 40%. Comparisons of prediction models revealed the following: ModelPET/VEGF-C versus ModelPET (P = .0069), ModelPET/VEGF-D versus ModelPET (P = .1886), ModelPET/VEGF-C/VEGF-D versus ModelPET (P = .0146), ModelPET/VEGF-C/VEGF-D versus ModelPET/VEGF-C (P = .2818), and ModelPET/VEGF-C/VEGF-D versus ModelPET/VEGF-D (P = .0095). In ModelPET/VEGF-C, higher VEGF-C levels were associated with an increased risk of nodal disease (odds ratio, 2.96; 95% confidence interval, 1.26-6.90). CONCLUSIONS Plasma levels of VEGF-C complemented the ability of PET to predict nodal disease among patients with suspected or confirmed NSCLC. VEGF-D did not improve prediction.
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Affiliation(s)
- Farhood Farjah
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash; Surgical Outcomes Research Center, University of Washington, Seattle, Wash.
| | - David K Madtes
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Wash; Division of Pulmonary and Critical Care Medicine, Fred Hutchinson Cancer Research Center, Seattle, Wash
| | - Douglas E Wood
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - David R Flum
- Surgical Outcomes Research Center, University of Washington, Seattle, Wash
| | - Megan E Zadworny
- Surgical Outcomes Research Center, University of Washington, Seattle, Wash
| | - Rachel Waworuntu
- Center for Lung Biology, University of Washington, Seattle, Wash
| | - Billanna Hwang
- Center for Lung Biology, University of Washington, Seattle, Wash
| | - Michael S Mulligan
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Wash; Center for Lung Biology, University of Washington, Seattle, Wash
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15
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Folch E, Costa DB, Wright J, VanderLaan PA. Lung cancer diagnosis and staging in the minimally invasive age with increasing demands for tissue analysis. Transl Lung Cancer Res 2015; 4:392-403. [PMID: 26380180 DOI: 10.3978/j.issn.2218-6751.2015.08.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/03/2015] [Indexed: 12/25/2022]
Abstract
The diagnosis and staging of patients with lung cancer in recent decades has increasingly relied on minimally invasive tissue sampling techniques, such as endobronchial ultrasound (EBUS) or endoscopic ultrasound (EUS) needle aspiration, transbronchial biopsy, and transthoracic image guided core needle biopsy. These modalities have been shown to have low complication rates, and provide adequate cellular material for pathologic diagnosis and necessary ancillary molecular testing. As an important component to a multidisciplinary team approach in the care of patients with lung cancer, these minimally invasive modalities have proven invaluable for the rapid and safe acquisition of tissue used for the diagnosis, staging, and molecular testing of tumors to identify the best evidence-based treatment plan. The continuous evolution of the field of lung cancer staging and treatment has translated into improvements in survival and quality of life for patients. Although differences in clinical practice between academic and community hospital settings still exist, improvements in physician education and training as well as adoption of technological advancements should help narrow this gap going forward.
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Affiliation(s)
- Erik Folch
- 1 Division of Thoracic Surgery and Interventional Pulmonology, 2 Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA ; 3 Baptist Memorial Hospital, Memphis, TN, USA ; 4 Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Daniel B Costa
- 1 Division of Thoracic Surgery and Interventional Pulmonology, 2 Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA ; 3 Baptist Memorial Hospital, Memphis, TN, USA ; 4 Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Jeffrey Wright
- 1 Division of Thoracic Surgery and Interventional Pulmonology, 2 Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA ; 3 Baptist Memorial Hospital, Memphis, TN, USA ; 4 Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Paul A VanderLaan
- 1 Division of Thoracic Surgery and Interventional Pulmonology, 2 Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA ; 3 Baptist Memorial Hospital, Memphis, TN, USA ; 4 Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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16
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Schirren M, Sponholz S, Oguhzan S, Kudelin N, Ruf C, Trainer S, Schirren J. [Intraoperative bleeding during thoracic surgery : avoidance strategies and surgical treatment concepts]. Chirurg 2015; 86:453-8. [PMID: 25995087 DOI: 10.1007/s00104-015-2999-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSRACT BACKGROUND As a direct result of the thoracic anatomy, heavy bleeding is possible during nearly all central resections in thoracic surgery. OBJECTIVE Description of the incidence of intraoperative bleeding including avoidance strategies and treatment concepts. Presentation of special anatomical features of pulmonary arteries. MATERIAL AND METHODS A literature search was performed in Pubmed, medline and by manual searching. Publications from the last 60 years were analyzed and the results are summarized in a structured review. RESULTS Little data is available on the incidence of intraoperative bleeding during thoracic surgery. Most data were collected retrospectively. For mediastinoscopy the incidence of severe bleeding is 0.2 %, for minimally invasive anatomical resections the incidence of intraoperative bleeding is 4.7 % and for open surgery 5 %. Bleeding from the central pulmonary artery can take a dramatic course and requires rapid and targeted therapy. DISCUSSION Knowledge of the anatomical topographic details, the structure, the course and the specific features of the vessels of the lungs is essential to prevent and treat bleeding. Avoidance strategies include techniques of proximal and distal vessel control, intrapericardial preparation and sharp preparation in general. Techniques of forward-looking preparation and well-prepared exit strategies in case of bleeding have to be part of the training in thoracic surgery.
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Affiliation(s)
- M Schirren
- Klinik für Thoraxchirurgie, Dr. Horst Schmidt Klinik GmbH, Klinikum der Landeshauptstadt Wiesbaden und der Helios Kliniken Gruppe, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland
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The Safety and Efficacy of Mediastinoscopy When Performed by General Thoracic Surgeons. Ann Thorac Surg 2014; 97:1878-83; discussion 1883-4. [DOI: 10.1016/j.athoracsur.2014.02.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/20/2014] [Accepted: 02/25/2014] [Indexed: 11/21/2022]
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18
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Dhillon SS, Dhillon JK, Yendamuri S. Mediastinal staging of non-small-cell lung cancer. Expert Rev Respir Med 2014; 5:835-50; quiz 851. [DOI: 10.1586/ers.11.75] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Abstract
Accurate staging of lung cancer is crucial to ensure the validity of lung cancer clinical research efforts and constitutes the cornerstone of the management of affected patients. The last decade has witnessed unprecedented technological advances allowing for more accurate and less invasive staging. In general, these techniques should be viewed as complementary rather than competitive, and indications, contraindications, and limitations of all staging techniques should be fully understood by providers involved with lung cancer patients. Noninvasive imaging techniques include chest computed tomography (CT) and positron emission tomography (PET). Invasive techniques can be nonsurgical such as needle-based techniques (endobronchial or endoscopic ultrasound) or surgical (mediastinoscopy and variants). The necessary multidisciplinary approach to lung cancer patients dictates that all stakeholders be familiar with the benefits and limitations of these newer techniques.
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Affiliation(s)
- Fabien Maldonado
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - James R Jett
- Division of Oncology, National Jewish Health, Denver, CO
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20
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A Prediction Model for Pathologic N2 Disease in Lung Cancer Patients with a Negative Mediastinum by Positron Emission Tomography. J Thorac Oncol 2013; 8:1170-80. [DOI: 10.1097/jto.0b013e3182992421] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Dhillon SS, Dexter EU. Advances in bronchoscopy for lung cancer. J Carcinog 2012; 11:19. [PMID: 23346012 PMCID: PMC3548337 DOI: 10.4103/1477-3163.105337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 12/13/2012] [Indexed: 12/14/2022] Open
Abstract
Bronchoscopic techniques have seen significant advances in the last decade. The development and refinement of different types of endobronchial ultrasound and navigation systems have led to improved diagnostic yield and lung cancer staging capabilities. The complication rate of these minimally invasive procedures is extremely low as compared to traditional transthoracic needle biopsy and surgical sampling. These advances augment the safe array of methods utilized in the work up and management algorithms of lung cancer.
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Affiliation(s)
- Samjot Singh Dhillon
- Department of Medicine Pulmonary Medicine and Thoracic Oncology, Roswell Park Cancer Institute, New York, USA ; Department of Medicine, State University of New York at Buffalo, New York, USA
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22
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Elsayed H. Reply to Rena and Casadio. Eur J Cardiothorac Surg 2012. [DOI: 10.1093/ejcts/ezs168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Nasir B, Cerfolio RJ, Bryant AS. Endobronchial ultrasound (EBUS) with tranbronchial needle aspiration (TBNA) versus mediastinoscopy for mediastinal staging in non-small cell lung cancer (NSCLC) thoracic cancer. Thorac Cancer 2012; 3:131-138. [DOI: 10.1111/j.1759-7714.2011.00106.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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24
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MAGE qPCR Improves the Sensitivity and Accuracy of EBUS-TBNA for the Detection of Lymphatic Cancer Spread. J Thorac Oncol 2012; 7:690-7. [DOI: 10.1097/jto.0b013e31824294de] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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25
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Smith SJ, Lyons OT, Patel AS, Clough RE, Salter R, Bell RE, Taylor PR. Endovascular repair of the aorta and aortic arch arteries damaged during mediastinoscopy. J Vasc Surg 2012; 55:1138-40. [DOI: 10.1016/j.jvs.2011.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/19/2011] [Accepted: 08/23/2011] [Indexed: 10/14/2022]
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26
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Rami-Porta R, Call S. Invasive staging of mediastinal lymph nodes: mediastinoscopy and remediastinoscopy. Thorac Surg Clin 2011; 22:177-89. [PMID: 22520285 DOI: 10.1016/j.thorsurg.2011.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Nodal status in lung cancer is essential for planning therapy and assessing prognosis. The involvement of ipsilateral and contralateral mediastinal lymph nodes is associated with poor prognosis and usually excludes patients from upfront surgical treatment. Mediastinoscopy is a time-honored procedure that allows the surgeon to access the upper mediastinal lymph nodes for either biopsy or removal. Remediastinoscopy is mainly indicated to assess objective tumor response in mediastinal lymph nodes after induction therapy for locally advanced lung cancer and to indicate further therapy.
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Affiliation(s)
- Ramón Rami-Porta
- Thoracic Surgery Service, Hospital Universitari Mutua Terrassa, University of Barcelona, Plaza Drive Robert 5, 08221 Terrassa, Barcelona, Spain.
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27
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Nikolaidis N, Roubelakis A, Shambrook JS, Ohri SK, Kaarne M, Weeden DF. An unusual complication from hemostatic packing to control bleeding during cervical mediastinoscopy and an off-pump approach for the later exploration of the superior vena caval injury. Ann Thorac Surg 2011; 92:1117-8. [PMID: 21871314 DOI: 10.1016/j.athoracsur.2011.03.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 03/02/2011] [Accepted: 03/07/2011] [Indexed: 11/15/2022]
Abstract
Cervical mediastinoscopy has been widely used and is considered a safe method for the histologic diagnosis and staging of many conditions. Hemorrhage still remains one of the main possible complications, and hemostasis is usually achieved without any further surgical intervention. We present a previously unreported complication of absorbable hemostatic gauze packing, which led to superior vena caval injury and multiple pulmonary emboli, necessitating further surgical repair with the use of a veno-venous shunt.
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Affiliation(s)
- Nicolas Nikolaidis
- Department of Cardiothoracic Surgery, Southampton University Hospital, Southampton, United Kingdom
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28
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Abstract
Mediastinoscopy is used for the staging of lung cancer and for the diagnosis of mediastinal lesions. It is a valuable diagnostic tool but, in a few cases, it could result in major complications. We describe a simple technique to avoid the development of a major complication--massive haemothorax--after a mediastinoscopy, which should be applied in cases of inadvertent injury of the pleura during the procedure.
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29
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Pulmonary artery injury during mediastinoscopy controlled without gauze packing. J Cardiothorac Surg 2011; 6:15. [PMID: 21303514 PMCID: PMC3042388 DOI: 10.1186/1749-8090-6-15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 02/08/2011] [Indexed: 11/26/2022] Open
Abstract
The most serious complication that can occur during mediastinoscopy is hemorrhage from large vessels in the mediastinum, whereas there are few articles relating to injury to major vessels. We describe a case of 77-year-old male with mediastinal lymphadenopathy, who underwent a mediastinoscopy procedure. When the pretracheal lymph nodes adjoining the right pulmonary artery were biopsied, a massive amount of bleeding spilled out through the scope. Immediately, the scope was removed from the body and the bleeding was controlled with digital compression at the skin incision. Then we closed the incision in a three-layer manner without any gauze packing in the mediastinum. Although some reports recommended gauze packing for massive bleeding during mediastinoscopy, we believe not all cases need gauze packing because bleeding from a low-pressure circulation system component into closed compartment, such as mediastinum, would cease without resulting in a large hematoma or pseudoaneurysm.
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30
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Nagayasu T, Tagawa T, Yamasaki N, Tsuchiya T, Miyazaki T. Successful management of severe pulmonary artery injury during mediastinoscopy. Gen Thorac Cardiovasc Surg 2011; 59:73-6. [PMID: 21225408 DOI: 10.1007/s11748-010-0633-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 04/04/2010] [Indexed: 11/28/2022]
Abstract
Although many reports have shown that mediastinoscopy is an extremely safe procedure, the most serious complication that can occur is hemorrhage from the large vessels in the mediastinum. A patient with severe pulmonary artery injury during mediastinoscopy that was successfully repaired through a right posterolateral thoracotomy is reported. Digital compression based on the anatomy was highly effective in controlling the hemorrhage caused by a longitudinal tear.
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Affiliation(s)
- Takeshi Nagayasu
- Division of Surgical Oncology, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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31
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Mediastinoscopy in Patients With Lung Cancer and Negative Endobronchial Ultrasound Guided Needle Aspiration. Ann Thorac Surg 2010; 90:1753-7. [DOI: 10.1016/j.athoracsur.2010.06.052] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 06/07/2010] [Accepted: 06/11/2010] [Indexed: 11/19/2022]
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32
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Karaiskos T, Karfis EA, Tsagaropoulou I, Drossos GE. Total circulatory arrest: a life-saving procedure for mediastinoscopic major hemorrhage. Gen Thorac Cardiovasc Surg 2010; 58:577-9. [PMID: 21069497 DOI: 10.1007/s11748-009-0533-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Accepted: 08/24/2009] [Indexed: 10/18/2022]
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33
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Kim YD, Park CB, Kim JJ, Kim CK, Moon SW. Primary Repair of an Iatrogenic Bronchial Rupture Under Video Mediastinoscopy. Ann Thorac Surg 2009; 87:e51-3. [DOI: 10.1016/j.athoracsur.2009.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 02/25/2009] [Accepted: 03/02/2009] [Indexed: 11/30/2022]
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34
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Mediastinoscopic Injuries to the Right Main Bronchus and Their Mediastinoscopic Repair. ACTA ACUST UNITED AC 2008. [DOI: 10.1097/lbr.0b013e31817eb7af] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Ernst A, Gangadharan SP. A Good Case for a Declining Role for Mediastinoscopy Just Got Better. Am J Respir Crit Care Med 2008; 177:471-2. [DOI: 10.1164/rccm.200710-1605ed] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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36
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Martin LW. Invasive mediastinal staging for non-small-cell lung cancer. Gastrointest Endosc 2008; 67:199-201. [PMID: 18226680 DOI: 10.1016/j.gie.2007.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 09/02/2007] [Indexed: 02/08/2023]
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37
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Hung JJ, Wu YC, Hsu HS, Wang KM, Hsu WH. Major hemorrhage and subsequent cardiac tamponade during mediastinoscopy. J Thorac Cardiovasc Surg 2007; 133:269-70. [PMID: 17198833 DOI: 10.1016/j.jtcvs.2006.08.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Accepted: 08/08/2006] [Indexed: 11/26/2022]
Affiliation(s)
- Jung-Jyh Hung
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
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Lemaire A, Nikolic I, Petersen T, Haney JC, Toloza EM, Harpole DH, D'Amico TA, Burfeind WR. Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann Thorac Surg 2006; 82:1185-9; discussion 1189-90. [PMID: 16996905 DOI: 10.1016/j.athoracsur.2006.05.023] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2006] [Revised: 05/04/2006] [Accepted: 05/08/2006] [Indexed: 01/12/2023]
Abstract
BACKGROUND Mediastinoscopy is a valuable tool for evaluating mediastinal pathology and is essential for establishing treatment strategies in most patients with lung cancer. We sought to determine the complication and false negative rate for mediastinoscopy in an institution that routinely performs this procedure. METHODS We performed a retrospective review of 2,145 consecutive mediastinoscopies at a single institution between April 1996 and April 2005. Demographics and complications were analyzed. In patients with lung cancer who underwent subsequent resection, the false negative rate was calculated. RESULTS Mean patient age was 61 +/- 0.4 years, and 58% (n = 1,253) were male. Pathology included lung cancer (n = 1,459), metastatic disease (n = 78), lymphoma (n = 51), and other benign disease (n = 557). Twenty-three patients (1.07%) experienced complications including hemorrhage (n = 7, 0.33%), vocal cord dysfunction (n = 12, 0.55%), tracheal injury (n = 2, 0.09%), and pneumothorax (n = 2, 0.09%). There was 1 death (0.05%) after pulmonary artery injury. Five of the 7 vascular injuries occurred during biopsy of level 4R. Three hundred and forty-three patients (23.5%) with lung cancer had positive mediastinoscopies. The false negative rate was 56 of 1,019 (5.5%) among lung cancer patients undergoing resection. Thirty-two (57%) of the false negatives were due to metastatic disease in lymph nodes not normally biopsied during cervical mediastinoscopy (levels 5, 6, 8, or 9). CONCLUSIONS Although invasive, mediastinoscopy identified locally advanced disease in a significant percentage of this lung cancer population and was associated with a low false negative rate. Complications after mediastinoscopy were uncommon. These results support the continued routine use of mediastinoscopy.
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Affiliation(s)
- Anthony Lemaire
- Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Lohser J. Reply: Mediastinoscopies Do Require a Preoperative Blood Type and Screen. J Cardiothorac Vasc Anesth 2006. [DOI: 10.1053/j.jvca.2006.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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40
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Mahmoud A, Pham H, Matolo N, Shrivastava D. Safety of Mediastinoscopy in Anatomical Variations of the Mediastinum: The Situs Inversus Syndrome. Am Surg 2006. [DOI: 10.1177/000313480607200115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mediastinoscopy has been widely used by thoracic surgeons to evaluate the superior mediastinum since 1959. Large series of mediastinoscopy have been reported with very low morbidity and no mortality. Proper attention to surgical techniques and mediastinal anatomy are essential to maintain the safety of the procedure. Situs inversus totalis is exceedingly rare, but variations in mediastinal anatomy in this group of patients can render the procedure challenging for the thoracic surgeon. A case of mediastinoscopy in a situs inversus patient is presented with emphasis on anatomical variations of the mediastinum and technical pitfalls of the procedure in this rare group.
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Affiliation(s)
- Ahmed Mahmoud
- Department of Surgery, San Joaquin General Hospital, French Camp, California
| | - Hien Pham
- Department of Surgery, San Joaquin General Hospital, French Camp, California
| | - Nathaniel Matolo
- Department of Surgery, San Joaquin General Hospital, French Camp, California
| | - Deepak Shrivastava
- Department of Surgery, San Joaquin General Hospital, French Camp, California
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Lohser J, Donington JS, Mitchell JD, Brodsky JB, Raman J, Slinger P. Case 5--2005: anesthetic management of major hemorrhage during mediastinoscopy. [clin conf]. J Cardiothorac Vasc Anesth 2005; 19:678-83. [PMID: 16202909 DOI: 10.1053/j.jvca.2005.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Indexed: 11/11/2022]
Affiliation(s)
- Jens Lohser
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305-5640, USA.
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Dosios T, Theakos N, Chatziantoniou C. Cervical Mediastinoscopy and Anterior Mediastinotomy in Superior Vena Cava Obstruction. Chest 2005; 128:1551-6. [PMID: 16162757 DOI: 10.1378/chest.128.3.1551] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES There is general agreement regarding the diagnostic efficacy of cervical mediastinoscopy (CMDS) and anterior mediastinotomy (AMDT) on patients with superior vena cava obstruction (SVCO), but controversy exists concerning the safety of these two diagnostic methods on that particular subset of patients. The purpose of the present study is to evaluate the safety and diagnostic efficacy of CMDS and AMDT in patients with SVCO. MATERIALS AND METHODS During the last 28 years, 39 consecutive patients with SVCO underwent biopsy of mediastinal lesions by CMDS (n = 18) or AMDT (n = 19) or both these techniques (n = 2). The medical records of all patients were reviewed, and demographic data, operative notes, perioperative complications, outcome, and histologic diagnoses were examined. The findings were compared with those of 367 patients without SVCO who underwent biopsy of mediastinal lesions during the same period of time. An up-to-date English-language literature search was performed. RESULTS The sensitivity of CMDS and/or AMDT in detecting malignancies in 39 patients with SVCO was 97.4%, specificity was 100%, and diagnostic accuracy was 97.4%. There was no in-hospital mortality, while morbidity consisted of five major complications and one minor complication, including two major hemorrhages and two airway obstructions. These patients, compared to those without SVCO, showed significantly higher postoperative morbidity (p < 0.001) and had a higher rate of malignancy (p < 0.001). Among 280 patients of the literature review, major hemorrhage was recorded in eight cases and airway obstruction in none. CONCLUSIONS CMDS and AMDT are effective methods to establish a histologic diagnosis in patients with SVCO. Although their mortality is negligible, they are accompanied by a significantly higher morbidity compared to patients without SVCO. Airway obstruction is a life-threatening complication that can occur in these patients. In our series, patients with SVCO had a higher rate of malignancy compared to patients without SVCO.
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Affiliation(s)
- Theodosios Dosios
- Second Department of Propedeutic Surgery, Division of Thoracic Surgery Athens University School of Medicine, 2 Chatzigianni Mexi Str, 11528, Athens, Greece.
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Abstract
INTRODUCTION The overall prognosis of non-small cell carcinoma of the bronchus (NSCLC) remains poor on account of frequently late diagnosis and associated co-morbidity preventing the optimal treatment of the tumour. Surgical resection remains the best curative treatment for limited stage disease. STATE OF THE ART The pre-operative assessment should determine whether the extent of the tumour permits complete resection and whether the physiological state of the patient would tolerate the curative resection required. The ultimate goal is to improve 5-year survival. In the case of initial inoperability the assessment should determine whether pre-operative oncological treatment might make an advanced tumour operable (e.g. stage IIIA), or whether targeted medical treatment might improve the patient sufficiently to tolerate an intervention initially judged too risky. The rapid development of the technical modalities available for the assessment requires a continuous review of the current practice guidelines. Positron emission tomography has considerably augmented the accuracy of classical radiological assessment. Nevertheless staging by imaging alone remains imprecise to the extent that invasive examinations are still necessary to provide histological proof of the clinical stage of NSCLC. The techniques for assessing mediastinal invasion are developing rapidly and becoming more accurate and less invasive. Mediastinoscopy enhanced by modern video technology, ultrasound guided endoscopic biopsies and thoracoscopy are complimentary rather than competing techniques. The functional assessment should estimate the operative risk of the proposed pulmonary resection, identify the targeted actions aimed at reducing this risk or, in the absence of such actions, suggest less invasive but less well validated surgical techniques or even palliative treatments. When the operative risk cannot be reduced its precise estimation at least allows the patient to decide whether the risk seems acceptable in relation to the chances of a cure. VIEWPOINT AND CONCLUSIONS In the future the pre-operative assessment of NSCLC should improve the detection of micro-metastases in order to optimise the choice of induction and adjuvant therapies. The increasing use of induction chemotherapy before surgical resection can only increase the importance of a detailed assessment for the selection of patients and the evaluation of results.
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Affiliation(s)
- G Decker
- Département de Chirurgie Thoracique, Groupe Thorax, Centre Hospitalier Luxembourg.
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