1
|
Shew M, Boyd C, Kraft S. Delayed Multifocal Tracheal Injury Following Thyroidectomy: A Case Report and Review of the Literature. Cureus 2020; 12:e8164. [PMID: 32550080 PMCID: PMC7296883 DOI: 10.7759/cureus.8164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Delayed presentation of tracheal injury after thyroidectomy is a rare complication. We present the case of a 24-year-old male presenting with findings of tracheal injury 12 days after total thyroidectomy. Upon surgical exploration, multifocal, transmural tracheal injuries were identified. Repair was performed with a combination of acellular dermal matrix allograft, local-regional flaps, silicone stenting, and tracheostomy. Herein we also review published cases of delayed tracheal injury. Our findings suggest that delayed tracheal necrosis and rupture is an uncommon yet potentially devastating complication of thyroidectomy. Surgeons should maintain a low threshold to suspect such injuries when patients present with neck swelling and subcutaneous emphysema, even up to 40 days post-operatively. Complex injuries may require a multidisciplinary approach and an armamentarium of reconstructive techniques.
Collapse
Affiliation(s)
- Matthew Shew
- Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, USA
| | - Christopher Boyd
- Otolaryngology - Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, USA
| | - Shannon Kraft
- Otolaryngology - Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, USA
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Mao F, Zhang L, Cai M, Ding Z, Shen-Tu Y. [The application of mediastinoscopy in the differential diagnosis and preoperative staging on lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:171-4. [PMID: 24581170 PMCID: PMC6000051 DOI: 10.3779/j.issn.1009-3419.2014.02.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
背景与目的 探讨纵隔镜检查术对纵隔肿物诊断和肺癌鉴别诊断/术前分期的临床应用价值。 方法 共计361例患者纳入研究,其中术前未确诊的纵隔肿物患者162例,疑诊或确诊肺癌并伴有纵隔淋巴结肿大(短径≥1.0 cm)患者199例。所有患者均接受手术,其中经颈纵隔镜检查术(SCM)308例,经胸骨旁纵隔镜检查术(PM)53例。 结果 ① 纵隔镜检查术对纵隔肿物诊断的准确性98.11%,敏感性97.62%,特异性100%,阳性预测值100%,阴性预测值91.67%。②纵隔镜检查术对肺癌纵隔淋巴结转移诊断的准确性98.28%,敏感性98.03%,特异性100%,阳性预测值100%,阴性预测值100%。手术相关并发症共计7例,发生率为1.93%。 结论 纵隔镜检查术创伤轻微、安全可靠、取材足量,对纵隔肿物的诊断价值极高,也是肺癌鉴别诊断和术前分期的重要方法和金标准。
Collapse
Affiliation(s)
- Feng Mao
- Department of Thoracic Cancer, Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Liang Zhang
- Department of 1st Medicine, Jilin Provincial Tumor Hospital, Changchun 130021, China
| | - Minghui Cai
- Department of Thoracic Cancer, Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Zhengping Ding
- Department of Thoracic Cancer, Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| | - Yang Shen-Tu
- Department of Thoracic Cancer, Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai 200030, China
| |
Collapse
|
4
|
Borges N, Saha S. The value of mediastinoscopy in the management of thoracic disease. Indian J Thorac Cardiovasc Surg 2012. [DOI: 10.1007/s12055-012-0144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
5
|
Complication Rates in Mediastinoscopy and Training: Video Versus Conventional Mediastinoscopy. Ann Thorac Surg 2012; 94:337; author reply 337-8. [DOI: 10.1016/j.athoracsur.2012.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 12/06/2011] [Accepted: 01/09/2012] [Indexed: 11/20/2022]
|
6
|
Sayar A, Çitak N, Metin M, Turna A, Pekçolaklar A, Kök A, Ürer N, Çelikten A, Ulukol ZN. Comparison of video-assisted mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy for lung cancer. Gen Thorac Cardiovasc Surg 2011; 59:793-8. [DOI: 10.1007/s11748-011-0819-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/11/2011] [Indexed: 10/14/2022]
|
7
|
Zakkar M, Tan C, Hunt I. Is video mediastinoscopy a safer and more effective procedure than conventional mediastinoscopy? Interact Cardiovasc Thorac Surg 2011; 14:81-4. [PMID: 22108943 DOI: 10.1093/icvts/ivr044] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether video-assisted mediastinoscopy (VAM) is a more effective procedure than conventional mediastinoscopy (CM). A total of 108 papers were identified using the search as discussed below. Of which, eight papers presented the best evidence to answer the clinical question as they included a sufficient number of patients to reach conclusions regarding the issues of interest for this review. Complications, complication rates, number of lymph nodes biopsies, number of stations sampled and training opportunities were included in the assessment. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. Literature search revealed that CM is a safe procedure associated with low mortality (0-0.05%) and morbidity (0-5.3%). CM has high levels of accuracy (83.8-97.2%) and negative predictive value (81-95.7%). Training in CM can be difficult as the limited vision means that the trainer cannot monitor directly the dissection and the areas biopsied by the trainee as one operator and effectively see at any time. VAM is also a safe procedure with comparable results to that of CM in term of mortality (0%), morbidity (0.83-2.9%), accuracy (87.9-98.9%) and negative predictive values (83-98.6%). The main advantage is higher number of biospsies taken (VAM, 6-8.5; CM, 5-7.13) and number of mediastinal lymph node stations sampled (VAM, 1.9-3.6; CM, 2.6-2.98). VAM can be associated with more aggressive dissecting and that can lead to more complications. The use of VAM can provide a better and safer training opportunity since both trainer and trainee can share the magnified image on the monitor. All studies available are comparing heterogeneous groups of non-matched group of patients which can bias the outcomes reported. There is a lack of comprehensive randomized studies to compare both procedures and to support any preference towards VAM over CM. We conclude that there is actually very little objective evidence of VAM superiority over CM.
Collapse
Affiliation(s)
- Mustafa Zakkar
- Department of Cardiothoracic Surgery, St. George's Hospital, London, UK.
| | | | | |
Collapse
|
8
|
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.
Collapse
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.
| | | | | | | | | |
Collapse
|
9
|
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]
|
10
|
Kalade AV, Eddie Lau WF, Conron M, Wright GM, Desmond PV, Hicks RJ, Chen R. Endoscopic ultrasound-guided fine-needle aspiration when combined with positron emission tomography improves specificity and overall diagnostic accuracy in unexplained mediastinal lymphadenopathy and staging of non-small-cell lung cancer. Intern Med J 2009; 38:837-44. [PMID: 19120534 DOI: 10.1111/j.1445-5994.2008.01670.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The aim of this study was to assess the incremental value of endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) to positron emission tomography (PET) in the diagnosis of unexplained mediastinal lymphadenopathy and staging of non-small-cell lung cancer (NSCLC). METHODS Patients who had both EUS-guided FNA and PET were retrospectively identified from an EUS database at a tertiary hospital. All EUS-guided FNA were carried out by one endoscopist between August 2002 and April 2005, either for the diagnosis of unexplained mediastinal lymphadenopathy or for the staging of NSCLC. Results of PET and EUS were compared with histology. A true histological positive result was defined as histological involvement in either surgery (mediastinoscopy or resection) or EUS-guided FNA. A true histological negative result was defined as negative involvement at surgery (mediastinoscopy or resection). RESULTS Forty-nine patients who had both PET scanning and EUS-guided FNA for diagnosis of unexplained mediastinal lymphadenopathy or staging of NSCLC were identified. Of these, 33 (73% males, n = 24, age range = 44-78 years, mean = 62 years) had surgical confirmation of mediastinal lymph node pathology. In these patients, PET alone showed sensitivity, 95%; specificity, 90%; positive predictive value, 87%; negative predictive value, 90% and accuracy, 88%; whereas the addition of EUS-guided FNA increased the overall specificity and positive predictive value to 100%, with an overall accuracy of 97%. CONCLUSIONS This study suggests that EUS-guided FNA complements PET by improving the overall specificity and thereby the accuracy for diagnosis of unexplained mediastinal lymphadenopathy. It provides a minimally invasive technique to assess the mediastinum in patients with NSCLC and is particularly valuable in cases in which PET findings are equivocal.
Collapse
Affiliation(s)
- A V Kalade
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.
| | | | | | | | | | | | | |
Collapse
|
11
|
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]
|
12
|
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]
|
13
|
Assaad MW, Pantanowitz L, Otis CN. Diagnostic accuracy of image-guided percutaneous fine needle aspiration biopsy of the mediastinum. Diagn Cytopathol 2007; 35:705-9. [DOI: 10.1002/dc.20738] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Oztuna F, Bülbül Y, Ozlü T. An Unusual Endobronchial Foreign Body: A Gauze That Migrated from the Mediastinum. Respiration 2005; 72:543-5. [PMID: 16210896 DOI: 10.1159/000087682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2003] [Accepted: 04/15/2004] [Indexed: 11/19/2022] Open
Abstract
The authors report a 48-year-old white male with lung cancer who was admitted to their clinic with a 1-year history of cough and shortness of breath. The patient was hospitalized because of progression of his complaints over 1 month. On the 3rd day of hospitalization, he expectorated a piece of gauze. The authors performed a fiber-optic bronchoscopy and saw pieces of gauze originating from granulation tissue located in the angle of the lower trachea and left main bronchi. A detailed anamnesis revealed that a mediastinoscopy had been performed 3 years ago for lung cancer staging: the gauze had migrated from the mediastinum to the endobrochial space.
Collapse
Affiliation(s)
- Funda Oztuna
- Karadeniz Technical University, School of Medicine, Department of Chest Diseases, Trabzon, Turkey.
| | | | | |
Collapse
|
16
|
Brandão DS, Boasquevisque CHR, Haddad R, Ponzio EDS. Tratamento cirúrgico de cisto broncogênico paratraqueal por mediastinoscopia cervical. J Bras Pneumol 2005. [DOI: 10.1590/s1806-37132005000400016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os cistos broncogênicos do mediastino são lesões benignas congênitas, usualmente descobertas na idade adulta. O tratamento cirúrgico clássico, quando indicado, é a ressecção da lesão por toracotomia ou por videotoracoscopia. Descrevemos aqui um caso em que foi realizada a ressecção completa de um cisto broncogênico paratraqueal por mediastinoscopia cervical, com uma breve revisão e discussão da literatura.
Collapse
Affiliation(s)
| | | | - Rui Haddad
- Universidade Federal do Rio de Janeiro, Brasil
| | | |
Collapse
|
17
|
Alzahouri K, Lejeune C, Woronoff-Lemsi MC, Arveux P, Guillemin F. Cost-effectiveness analysis of strategies introducing FDG-PET into the mediastinal staging of non-small-cell lung cancer from the French healthcare system perspective. Clin Radiol 2005; 60:479-92. [PMID: 15767106 DOI: 10.1016/j.crad.2004.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2004] [Revised: 10/03/2004] [Accepted: 10/08/2004] [Indexed: 10/25/2022]
Abstract
AIM To determine the most cost-effective strategy using PET for mediastinal staging of potentially operable non-small-cell lung cancer (NSCLC). METHODS Four decision strategies based on French NSCLC work-up practices for the selection of potential surgical candidates were compared, comprising CT only, PET for negative CT, PET for all with anatomical CT, and CT and PET for all cases. The medical literature was surveyed to obtain values for all variables of interest. Costs were assessed with reimbursements from the French healthcare insurance for the year 1999. Expected cost and life expectancy were calculated for all possible outcomes of each strategy. Sensitivity analysis was performed to determine the effects of changing variables on the expected cost and life expectancy. RESULTS Compared with the CT only strategy, CT and PET for all resulted in a relative reduction of 70% of surgery for persons with mediastinal lymph node metastasis. PET for all with anatomical CT was shown to be a cost-effective alternative to the CT only, with life expectancy increased by 0.10 years and expected cost savings of 61 euros. This strategy was more favourable than PET for negative CT. Overall, sensitivity analyses showed the robustness of the results. CONCLUSION The introduction of thoracic PET for NSCLC staging is potentially cost-effective in France. Further clinical investigation might help to validate this result.
Collapse
Affiliation(s)
- K Alzahouri
- CEC-Inserm, Service d'Epidémiologie et Evaluation Cliniques, C.H.U. de Nancy, Nancy, France
| | | | | | | | | |
Collapse
|
18
|
Kouerinis IA, Loutsidis AE, Hountis PA, Apostolakis EE, Bellenis IP. Treatment of Iatrogenic Injury of Membranous Trachea With Intercostal Muscle Flap. Ann Thorac Surg 2004; 78:e85-6. [PMID: 15511420 DOI: 10.1016/j.athoracsur.2004.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 11/16/2022]
Abstract
Iatrogenic injuries of the membranous trachea are rare but potentially lethal, and most commonly require surgical treatment. Such injuries occur intraoperatively during specific thoracic surgery procedures or are associated with endotracheal anesthesia. Special technical difficulties in managing them surgically are encountered when lacerations are in proximity to the rigid rings of the trachea because of the lack of membranous tissue distal to the tear. We describe our technique used in a patient with such an iatrogenic tracheal injury during resection of invasive lung carcinoma.
Collapse
Affiliation(s)
- Ilias A Kouerinis
- Department of Cardiothoracic Surgery, Evangelismos Hospital, Athens, Greece
| | | | | | | | | |
Collapse
|
19
|
Semik M, Netz B, Schmidt C, Scheld HH. Surgical exploration of the mediastinum: mediastinoscopy and intraoperative staging. Lung Cancer 2004; 45 Suppl 2:S55-61. [PMID: 15552782 DOI: 10.1016/j.lungcan.2004.07.992] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Lung resection remains the therapy of choice offering the greatest potential for cure in non-spread lung cancer. Prognostic importance of lymph-node involvement has been underlined by several studies. So, exploration of the mediastinum is of major importance for defining the therapeutic strategy in a possibly curative setting. Pre-resectional exploration of the mediastinal lymph-nodal status is mandatory to define tumour stage exactly and establish specific therapy. Cervical mediastinoscopy is the primary diagnostic procedure and remains the gold standard in invasive surgical staging. Complementary, parasternal mediastinoscopy, extended mediastinoscopy, and video-assisted thoracoscopy may be performed. These techniques allow accurate assessment of mediastinal lymph-node involvement, resulting in an appropriate judgement as to resectability and possible treatment options. Different techniques are established for intraoperative exploration and staging. In terms of curative surgery of lung cancer we demand accurate staging which is achieved by systematic and complete Lymph-node dissection. So, individually and dependent on primary tumour site, accurate mediastinal staging of Lung cancer should be performed in combination with definitive lung resection.
Collapse
Affiliation(s)
- Michael Semik
- Dept. of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Albert-Schweitzer-Str. 33, D-48128 Münster, Germany.
| | | | | | | |
Collapse
|
20
|
Abstract
Many patients with early stage lung cancer (stage I and II) are curable by surgical resection. In patients with locally advanced disease surgery plays an important role in order to provide local tumor control. Therefore, the aim of all staging efforts in NSCLC must be to identify all patients, who might be potential candidates for a surgical approach. Current staging tools include imaging techniques like CT- and PET-scan, transthoracic, transbronchial or transeosophageal needle biopsies and finally surgical staging methods including mediastinoscopy and video-assisted thoracoscopic surgery (VATS). With respect to mediastinal lymph node staging, cervical mediastinoscopy is reported to have a sensitivity between 81 and 89%. This mainly due to the fact, that some lymph node levels (# 8, 9, 5, 6) are not accessible by the standard cervical approach. The morbidity and mortality of cervical mediastinoscopy is in experienced centers only minimal. In series with more than 1000 patients, the mortality was almost 0% and morbidity varied between 0.5 and 1%. Cervical mediastinoscopy can be performed also as an outpatient procedure. In addition to 'simple' lymph node staging, mediastinoscopy clarifies the local resectability of central tumors (T-factor). Currently, cervical mediastinoscopy is recommended by almost all scientific societies in patients with apparently resectable NSCLC who present with enlarged mediastinal lymph nodes of >1 cm in short axis diameter. Video-mediastinoscopy allows that the procedure gets even more standardized and preliminary data suggest that the sensitivity might be improved in comparison to conventional mediastinoscopy. Since VATS is widely accepted by the community of thoracic surgeons, it has become an important staging tool in many situations. VATS can be used to rule out or confirm a suspected contralateral lung metastasis. Furthermore, VATS is extremely useful to exclude malignant pleural effusions in otherwise operable patients. This examination can be done in the operating room immediately prior to formal thoracotomy. Additionally, VATS is effective to explore the local resectability in patients with suspected mediastinal infiltration or a lymphangiosis carcinomatosa within the mediastinum. VATS allows an accurate staging of more than 90% of the patients with suspected stage IIIB NSCLC. With respect to lymph node staging, VATS is complimentary to cervical mediastinoscopy because it helps to stage the lymph nodes in the A-P. window (#5, 6), as well as the lymph nodes paraesophageal (#8) and in the pulmonary ligament (#9). In conclusion, surgical staging methods provide a 100% specificity in combination with a high sensitivity and only a minimal morbidity. Currently, surgical staging is recommended by the majority of scientific societies for the staging of patients with apparently resectable NCSLC.
Collapse
Affiliation(s)
- Bernward Passlick
- Department of Thoracic Surgery, Asklepios-Fachkliniken München-Gauting, Klinik für Thoraxchirurgie, Robert-Koch-Allee 2, D-82131 Gauting, Germany.
| |
Collapse
|
21
|
Abstract
OBJECTIVE The management of major hemorrhage complicating mediastinoscopy is not well described. We reviewed our experience to determine the frequency, optimal management strategy, and outcome of these injuries. METHODS A retrospective review of all mediastinoscopies performed at a single institution during a 12-year period (January 1990-January 2002) was performed. Major hemorrhage was defined as that requiring exploration for definitive control. RESULTS During the study period, 3391 mediastinoscopies were performed. Fourteen patients (0.4%) experienced major hemorrhage. Most patients (12/14) had non-small cell lung cancer, and only 1 patient each underwent preoperative radiation, repeat mediastinoscopy, or extended mediastinoscopy. The most common biopsy site (4/14 cases) resulting in major hemorrhage was the lower right paratracheal region (level 4R), and the most frequently injured vessels were the azygos vein and the innominate and pulmonary arteries. Initial control of hemorrhage was achieved through packing in 93% (13/14), and the most common initial approach for exploration was sternotomy (8/14). Four patients underwent a planned pulmonary resection after definitive control of bleeding. The median amount of blood transfused was 2 units (range 0-18 units). Postoperative complications occurred in 2 of 14 patients (14%). There were no intraoperative deaths, but 1 patient died postoperatively (1/14, 7% mortality). The median postoperative length of stay was 6 days (range 1-19 days). CONCLUSIONS Major hemorrhage during mediastinoscopy is an uncommon but potentially morbid event. Initial control can usually be achieved through packing. Subsequent management presents a technical challenge but can result in minimal morbidity and mortality.
Collapse
Affiliation(s)
- Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-867, New York, NY 10021, USA.
| | | | | | | | | |
Collapse
|
22
|
Abstract
The etiology, presentation, and management of blunt and penetrating injuries of the trachea has been reviewed. The approach to and outcome following management of more unusual situations such as iatrogenic injuries has also been briefly reviewed. Early recognition of these problems and careful attention to the details of acute management can convert a life-threatening situation into one that can usually be successfully managed by the techniques of tracheal surgery developed and popularized by Dr. Grillo.
Collapse
Affiliation(s)
- Joseph B Shrager
- Section of General Thoracic Surgery, 4 Silverstein Building, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia. PA 19104, USA.
| |
Collapse
|
23
|
Graeter TP, Hellwig D, Hoffmann K, Ukena D, Kirsch CM, Schäfers HJ. Mediastinal lymph node staging in suspected lung cancer: comparison of positron emission tomography with F-18-fluorodeoxyglucose and mediastinoscopy. Ann Thorac Surg 2003; 75:231-5; discussion 235-6. [PMID: 12537221 DOI: 10.1016/s0003-4975(02)04350-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In patients with bronchogenic carcinoma, mediastinal lymph node staging is essential for determining treatment options. In this retrospective analysis we compared the results of positron emission tomography (PET) using F-18 fluorodeoxyglucose with those of mediastinoscopy in nodal staging for suspected bronchogenic carcinoma. METHODS From March 1997 to June 2001, 102 patients (86 male,16 female, age 62 +/- 9 years) underwent both PET and mediastinoscopy for radiologically suspected mediastinal lymph node disease in bronchogenic carcinoma. Total body emission scans were acquired 90 to 150 minutes after injection of 230 MBq of F-18 fluorodeoxyglucose. Mediastinoscopic evaluation of lymph node stations was performed according to the method of Mountain and Dresler (1R, 1L, 2L, 2R, 4L, 4R,7). Patients were eligible if surgical staging was performed within 6 weeks after the PET scan. RESULTS. Of the 102 patients, benign lesions were diagnosed in 15. In 87 patients malignant disease was proven by histology, and bronchogenic carcinoma was found in 82. Of 469 nodal stations analyzed, malignancy was documented by histology in 84. In PET analysis 79 true-positive and 304 true-negative samples were found. Five lymph node stations were false negative, and 81 samples were false positive. False-positive findings in PET frequently were seen in inflammatory lung disease. The sensitivity of PET was 94.1%, specificity was 79% with a diagnostic accuracy of 81.6%. The positive predictive value of PET was 49.3%, and the negative predictive value was 98.4%. CONCLUSIONS In patients with positive PET scan results histologic verification appears necessary for exact lymph node staging. In view of the negative predictive value mediastinoscopy can be omitted in patients with bronchogenic carcinoma whose PET scan results were negative.
Collapse
Affiliation(s)
- Thomas P Graeter
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical School, Homburg/Saar, Germany.
| | | | | | | | | | | |
Collapse
|
24
|
Brega Massone PP, Conti B, Magnani B, Lequaglie C, Cataldo I. Video-assisted thoracoscopic surgery for diagnosis, staging, and management of lung cancer with suspected mediastinal lymphadenopathy. Surg Laparosc Endosc Percutan Tech 2002; 12:104-9. [PMID: 11948296 DOI: 10.1097/00129689-200204000-00006] [Citation(s) in RCA: 7] [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
The aim of this report was to evaluate the effectiveness of video-assisted thoracoscopic surgery (VATS) in staging, diagnosis, and treatment of lung cancer. Fifty-two patients were scheduled for mediastinal lymph node VATS biopsy at the Oncologic Thoracic Surgery Department of the National Cancer Institute in Milan. Fifty patients underwent lymph nodal thoracoscopic biopsy (96%), whereas for the other 2 patients, histologic diagnosis was done by pleural metastatic nodule thoracoscopic biopsy (4%). We performed 17 lymph nodal biopsies in level 5 (33%), 14 in level 6 (27%), 12 in level 7 (23%), and 7 in level 8 (13%). No postoperative complications were observed, and 19 subjects (36%) underwent open lung resection. The histologic diagnosis was adenocarcinoma in 25 cases (48%), epidermoid carcinoma in 14 (27%), microcytoma in 9 (17%), and giant-cell lung carcinoma in 4 (8%); 10 patients were at stage I (19%), 9 at stage II (17%), 31 at stage III (60%), and 2 at stage IV (4%). The use of VATS allowed diagnosis of the suspected involved mediastinal lymph nodes in lung cancer patients and obviated the need for painful thoracotomy, enabling accurate staging and thus selection of the optimal treatment.
Collapse
Affiliation(s)
- P P Brega Massone
- Oncologic Thoracic Surgery Department, National Cancer Institute, Milan, Italy.
| | | | | | | | | |
Collapse
|
25
|
Zwischenberger JB, Savage C, Alpard SK, Anderson CM, Marroquin S, Goodacre BW. Mediastinal transthoracic needle and core lymph node biopsy: should it replace mediastinoscopy? Chest 2002; 121:1165-70. [PMID: 11948048 DOI: 10.1378/chest.121.4.1165] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Primary assessment of mediastinal lymph nodes (N2 or N3) for staging lung cancer by transthoracic needle with or without core biopsy. Mediastinoscopy only performed after FNA failed to yield a diagnosis. DESIGN AND SETTINGS A retrospective study in a university setting. PATIENTS Eighty-nine patients with mediastinal lymphadenopathy (> 1.5 cm in short-axis diameter) by CT. METHODS Mediastinal transthoracic fine-needle aspiration (FNA) with or without core biopsy was performed prior to mediastinoscopy in 89 patients with mediastinal lymphadenopathy (lymph node > 1.5 cm in short-axis diameter) or masses by CT. RESULTS Mediastinal transthoracic FNA was used alone in 39 of 89 patients, or with core biopsy in 50 of 89 patients. Mediastinal transthoracic FNA with or without core biopsy was diagnostic in 69 of 89 patients (77.5%) for cancer cell type, sarcoidosis, or caseating granulomas with or without tuberculosis. Transthoracic FNA with or without core biopsy of nodal stations (total, 94 biopsies) judged readily accessible by mediastinoscopy (n = 59) included paratracheal (n = 56) and highest mediastinal (n = 3); those more difficult (n = 26) included subcarinal (n = 20) and aorticopulmonary window (n = 6); and those impossible (n = 9) included paraesophageal and pulmonary ligament (n = 6), parasternal (n = 2), and para-aortic (n = 1). Innovative lung protective techniques for CT-guided biopsy access windows included "iatrogenic-controlled pneumothorax" (n = 10) or saline solution injection creating a "salinoma" (n = 11). Pneumothorax was detected in only 10% with a "protective" technique but 60% when traversing lung parenchyma. Transthoracic FNA with or without core biopsy failed to yield a diagnosis in 20 of 89 patients (22.5%); all then underwent mediastinoscopy, with 11 of 20 procedures (55%) diagnostic for cancer, and 9 of 20 procedures diagnostic of benign diagnosis or no cancer. CONCLUSION Transthoracic FNA with or without core biopsy accesses virtually all mediastinal nodal stations is diagnostic in 78% of cases with mediastinal adenopathy or masses, and should precede mediastinoscopy in the staging of lung cancer or workup of mediastinal masses.
Collapse
|
26
|
Schmidli J, Vogt PR, Genoni M, Turina MI. Surgical management of severe common carotid artery injury after mediastinoscopy. Ann Thorac Surg 2001; 72:2107-9. [PMID: 11789803 DOI: 10.1016/s0003-4975(01)02697-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Mediastinoscopy is a widely used method to achieve pathologic diagnosis of enlarged lymph nodes or undefined mediastinal solid mass. Aortic arch penetration and injury of the supraaortic arteries are rare but very dangerous complications of mediastinoscopy. We describe the hazardous transportation of a 57-year-old woman after mediastinoscopic injury of the right common carotid artery and its successful repair with cardiopulmonary bypass and deep hypothermia.
Collapse
Affiliation(s)
- J Schmidli
- Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
| | | | | | | |
Collapse
|
27
|
Hujala KT, Sipilä JI, Grénman R. Mediastinoscopy--its role and value today in the differential diagnosis of mediastinal pathology. Acta Oncol 2001; 40:79-82. [PMID: 11321666 DOI: 10.1080/028418601750071109] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Mediastinoscopy has been an important method in the differential diagnosis of mediastinal pathology since it was presented by Carlens in 1959. Present investigation methods in radiology such as computed tomography and magnetic resonance imaging as well as the new developments in ultrasonography have resulted in a decrease in the number of mediastinoscopies performed. In addition, better results of fine-needle aspiration and core-needle biopsy investigations together with new techniques in thoracoscopy have brought alternative possibilities in examining mediastinal masses. To evaluate the role of mediastinoscopy today, a retrospective study was conducted comprising 249 consecutive patients who had undergone mediastinoscopy in the years 1989 1997 at Turku University Central Hospital. Mediastinoscopy was technically possible in 229 of the 249 cases (92.0%) and a definitive diagnosis was obtained in 210 cases (84.3%). The mortality rate was zero and only 13 complications (5.2%) were reported. Six cases of paresis of the left recurrent nerve were reported, four of which were temporary. There were also five minor intraoperative and two postoperative bleedings, which were easily controlled. We still consider mediastinoscopy as a safe and efficient way of examining mediastinal pathology.
Collapse
Affiliation(s)
- K T Hujala
- Department of Otorhinolaryngology, North Carelia Central Hospital, Joensuu, Finland
| | | | | |
Collapse
|
28
|
Wood DE. Commentary on “Image-Guided Fine Needle Aspirate Strategies for Staging of Lung Cancer”. Clin Lung Cancer 2000. [DOI: 10.1016/s1525-7304(11)70631-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
29
|
Hammoud ZT, Anderson RC, Meyers BF, Guthrie TJ, Roper CL, Cooper JD, Patterson GA. The current role of mediastinoscopy in the evaluation of thoracic disease. J Thorac Cardiovasc Surg 1999; 118:894-9. [PMID: 10534695 DOI: 10.1016/s0022-5223(99)70059-0] [Citation(s) in RCA: 184] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Mediastinoscopy is a common procedure used for the diagnosis of thoracic disease and the staging of lung cancer. We sought to determine the current role of mediastinoscopy in the evaluation of thoracic disease. METHODS We conducted a retrospective review of all mediastinoscopies performed by members of our service between January 1988 and September 1998. RESULTS We performed mediastinoscopies on 2137 patients. A total of 1745 patients underwent mediastinoscopy for known or suspected lung cancer. In 422 of these procedures, N2 or N3 disease was identified; only 28 of these patients underwent resection. The remaining 1323 had no evidence of metastatic disease. In these patients 947 had lung cancer. Only 76 of the patients with lung cancer were found to have N2 disease at exploration. Among the 1323 patients with a negative mediastinoscopy result, 52 underwent resection of a nonbronchogenic malignancy, and 217 had resection of a benign lesion. A total of 392 patients underwent mediastinoscopy for the evaluation of mediastinal adenopathy in the absence of any identifiable pulmonary lesion. Of these, 161 had a nonbronchogenic malignancy, 209 had benign disease, and 25 had no diagnosis established; mediastinoscopy established a definitive diagnosis in 93.6% of patients. In the entire group of 2137 patients, there were 4 perioperative deaths and 12 complications. Only one death was directly attributed to mediastinoscopy. No deaths or complications occurred in patients undergoing mediastinoscopy for benign disease. CONCLUSIONS Mediastinoscopy is a highly effective and safe procedure. We believe that mediastinoscopy should currently be used routinely in the diagnosis and staging of thoracic diseases.
Collapse
Affiliation(s)
- Z T Hammoud
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO, USA
| | | | | | | | | | | | | |
Collapse
|
30
|
Martín de Nicolás Serrahima J, García Barajas S, Marrón Fernández C, Díaz-Hellín Gude V, Larrú Cabrero E, Oteo Lozano M, Pérez Antón J, Toledo González J. Complicaciones técnicas de la exploración quirúrgica del mediastino en la estadificación del cáncer de pulmón. Arch Bronconeumol 1999. [DOI: 10.1016/s0300-2896(15)30056-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
31
|
Abstract
STUDY OBJECTIVE Evaluate the use of mediastinoscopy in the surgical diagnosis and treatment of mediastinal cystic masses in adults. DESIGN Case reports and literature review. SETTING Academic department of surgery. PATIENTS Three consecutive adults with mediastinal masses identified on plain radiographs and CT. INTERVENTIONS Operative mediastinoscopy. MEASUREMENTS AND RESULTS All patients were successfully treated with removal of cyst wall, establishment of diagnosis, and same-day hospital discharge. CONCLUSIONS Simple mediastinoscopic removal of mediastinal cysts offers the same potential for diagnosis and treatment as more conventional methods, with a potential for less morbid and more cost-effective care.
Collapse
Affiliation(s)
- W R Smythe
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA
| | | | | |
Collapse
|
32
|
Varela G, Jiménez MF, López S, Mínguez F. [Descriptive study of complications caused by mediastinoscopy]. Arch Bronconeumol 1998; 34:119-22. [PMID: 9611635 DOI: 10.1016/s0300-2896(15)30466-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To analyze the surgical and non surgical complications of mediastinoscopy in a series of 200 consecutive patients. Retrospective study of all surgical patients between 1 January 1994 and 1 May 1997. Any complication presenting between time of surgery and patient release is analyzed. Complications were seen in 8 out of 200 cases (4%). In three cases, there were lesions in neighboring structures (recurrent nerve, bronchial artery and innominate artery). The rest were non surgical complications (3 cases of arrhythmia, 2 of prolonged mechanical ventilation). One male patient (0.5%) died from cerebral infarction, probably as a result of arterial occlusion needed to suture damage to the innominate artery. Superior win cava syndrome affected 20% (1 in 5) and morbidity was 60% (3 in 5). Morbidity involving both medical and surgical complications in this series is higher than that reported elsewhere in the literature, in series for which non surgical complications go unreported.
Collapse
Affiliation(s)
- G Varela
- Sección de Cirugía Torácica, Hospital Universitario, Salamanca
| | | | | | | |
Collapse
|
33
|
Gossot D, Toledo L, Fritsch S, Celerier M. Mediastinoscopy vs thoracoscopy for mediastinal biopsy. Results of a prospective nonrandomized study. Chest 1996; 110:1328-31. [PMID: 8915241 DOI: 10.1378/chest.110.5.1328] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the results and the morbidity of thoracoscopy compared with conventional mediastinoscopy for the approach of mediastinal solid masses and lymph nodes, we have performed a prospective study about the respective yields, complication rates, and the length of hospital stay for patients. MATERIAL AND METHODS We have included 114 patients in the study. The criteria of inclusion were the accessibility of the lymph nodes and/or mass to cervical mediastinoscopy through CT scan view. There were 2 groups: 52 patients underwent a mediastinoscopy (group M) and 62 underwent a thoracoscopy (group T). RESULTS There were 3 failures in group M (5.7%) and 5 failures in group T (8.1%) (not significant; NS). In group M, the three procedures were converted to anterior mediastinotomy (two cases) and to thoracoscopy (one case). In group T, the five procedures were converted to anterior mediastinotomy (two cases), mediastinoscopy (two cases), and thoracotomy (one case). The diagnostic yield was 94.3% in group M and 91.9% in group T (NS). After conversion, a diagnosis was reached in all patients in group M (100%) and in all but 1 patient in group T (98.3%) (NS). There was no intraoperative complication in group M, while 2 complications occurred in group T (3.2%) (p < 0.05). The overall morbidity was zero in group M and 4.8% in group T (p < 0.05). CONCLUSION The diagnostic yield of mediastinoscopy is comparable to thoracoscopy. Complication rate and hospital stay of patients undergoing mediastinoscopy are significantly inferior. Thoracoscopy should be indicated only for lesions that are not within the reach of the mediastinoscope or when multiple biopsy specimens are necessary.
Collapse
Affiliation(s)
- D Gossot
- Department of Surgery, Saint-Louis Hospital, Paris, France
| | | | | | | |
Collapse
|
34
|
Urschel JD, Vretenar DF, Dickout WJ, Nakai SS. Cerebrovascular accident complicating extended cervical mediastinoscopy. Ann Thorac Surg 1994; 57:740-1. [PMID: 8147650 DOI: 10.1016/0003-4975(94)90579-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The safety and efficacy of staging cervical mediastinoscopy is well established. Extended cervical mediastinoscopy has been proposed as a safe and effective method of staging left upper lobe lung cancers. We report a case of cerebrovascular accident complicating extended cervical mediastinoscopy.
Collapse
Affiliation(s)
- J D Urschel
- Thoracic Diseases Unit, Misericordia Hospital, Edmonton, Alberta, Canada
| | | | | | | |
Collapse
|
35
|
|
36
|
Abstract
There is little written in the literature regarding the management of major bronchial disruptions occurring during mediastinoscopy. This report illustrates the use of an in-continuity flap bronchoplasty of middle lobe bronchial tissue to repair such an iatrogenic intermediate bronchus injury.
Collapse
Affiliation(s)
- S L Schubach
- Section of General Thoracic Surgery, University of Pittsburgh, Pennylvania 15213
| | | |
Collapse
|
37
|
Vueghs PJ, Schurink GA, Vaes L, Langemeyer JJ. Anesthesia in repeat mediastinoscopy: a retrospective study of 101 patients. J Cardiothorac Vasc Anesth 1992; 6:193-5. [PMID: 1568006 DOI: 10.1016/1053-0770(92)90197-f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In most medical textbooks, a mediastinoscopy is considered an absolute contraindication for a repeat mediastinoscopy. Retrospectively, perioperative data from 101 patients were evaluated in whom repeat mediastinoscopy was performed. The complication rate was 23% in 18 patients; 10% of these were directly related to the surgery. The surgical complications observed were hemorrhage, biopsy of the esophagus, paresis of a recurrent laryngeal nerve, and pneumothorax, which were all treated successfully. The patients receiving a nondepolarizing relaxant had fewer complications than patients given only a single dose of succinylcholine. In this patient population, the mortality rate was zero. This review concludes that an earlier mediastinoscopy is not necessarily an absolute contraindication for repeat mediastinoscopy.
Collapse
Affiliation(s)
- P J Vueghs
- Department of Anesthesiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | | |
Collapse
|
38
|
Noble HB, Porter M, Qian K, Tan QY, Wang RW, Deng B, Zhou JH. The role of the team physician in school athletics. BMC Pulm Med 1982; 18:146. [PMID: 30176840 PMCID: PMC6122670 DOI: 10.1186/s12890-018-0713-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/23/2018] [Indexed: 12/15/2022] Open
Abstract
Background Convenient approaches for accurate biopsy are extremely important to the diagnosis of lung cancer. We aimed to systematically review the clinical updates and development trends of approaches for biopsy, i.e., CT-guided PTNB (Percutaneous Transthoracic Needle Biopsy), ENB (Electromagnetic Navigation Bronchoscopy), EBUS-TBNA (Endobroncheal Ultrasonography-Transbronchial Needle Aspiration), mediastinoscopy and CTC (Circulating Tumor Cell). Methods Medline and manual searches were performed. We identified the relevant studies, assessed study eligibility, evaluated methodological quality, and summarized diagnostic yields and complications regarding CT-guided PTNB (22 citations), ENB(31 citations), EBUS-TBNA(66 citations), Mediastinoscopy(15 citations) and CTC (19 citations), respectively. Results The overall sensitivity and specificity of CT-guided PTNB were reported to be 92.52% ± 3.14% and 97.98% ± 3.28%, respectively. The top two complications of CT-guided PTNB was pneumothorax (946/4170:22.69%) and hemorrhage (138/1949:7.08%). The detection rate of lung cancer by ENB increased gradually to 79.79% ± 15.34% with pneumothorax as the top one complication (86/1648:5.2%). Detection rate of EBUS-TBNA was 86.06% ± 9.70% with the top three complications, i.e., hemorrhage (53/8662:0.61%), pneumothorax (46/12432:0.37%) and infection (34/11250:0.30%). The detection rate of mediastinoscopy gradually increased to 92.77% ± 3.99% with .hoarseness as the refractory complication (4/2137:0.19%). Sensitivity and specificity of CTCs detection by using PCR (Polymerase Chain Reaction) were reported to be 78.81% ± 14.72% and 90.88% ± 0.53%, respectively. Conclusion The biopsy approaches should be chosen considering a variety of location and situation of lesions. CT-guided PTNB is effective to reach lung parenchyma, however, diagnostic accuracy and incidence of complications may be impacted by lesion size or needle path length. ENB has an advantage for biopsy of smaller and deeper lesions in lung parenchyma. ENB plus EBUS imaging can further improve the detection rate of lesion in lung parenchyma. EBUS-TBNA is relatively safer and mediastinoscopy provides more tissue acquisition and better diagnostic yield of 4R and 7th lymph node. CTC detection can be considered for adjuvant diagnosis.
Collapse
Affiliation(s)
| | | | - Kai Qian
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Qun-You Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Ru-Wen Wang
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Bo Deng
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China.
| | - Jing-Hai Zhou
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China.
| |
Collapse
|