1 / 19

Mediastinoscopy vs. VATS

Mediastinoscopy vs. VATS. G. Alexander Patterson, MD Evarts A. Graham Professor of Surgery Chief, Department of Cardiothoracic Surgery Washington University School of Medicine Barnes-Jewish Hospital. History of Mediastinal Staging of NSCLC. Cervical mediastinoscopy

alder
Télécharger la présentation

Mediastinoscopy vs. VATS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Mediastinoscopy vs. VATS G. Alexander Patterson, MD Evarts A. Graham Professor of Surgery Chief, Department of Cardiothoracic Surgery Washington University School of Medicine Barnes-Jewish Hospital

  2. History of Mediastinal Staging of NSCLC • Cervical mediastinoscopy • Carlens (Karolinska Institute – Sweden) Dis Chest 1959; 36:343. • Pearson(University of Toronto – Canada) JTCVS 1965; 49:11.

  3. History of Mediastinal Staging of NSCLC • 1966: Anterior mediastinotomy • Chamberlain (Aortopulmonary window) Ann Thorac Surg 1966; 22:260.

  4. History of Mediastinal Staging of NSCLC • 1987: Extended mediastinoscopy • Ginsberg (University of Toronto) JTCVS 1987; 94:673.

  5. Prof. Antoon Lerut • 3-field lymphadenectomy • Video mediastinoscopy

  6. TxN1 NSCLCa

  7. Mediastinoscopy • Retrospective review of 2,137 patients who underwent mediastinoscopy over a 10-year period • 1,369 patients with lung cancer • 422 patients had metastatic carcinoma identified in the mediastinal nodes • 947 had a thoracotomy after negative mediastinoscopy • 76 (8%) patients were subsequently found to have mediastinal lymph nodes that contained metastatic carcinoma Hammoud et al. J ThoracCardiovascSurg 1999;118:894-9

  8. Mediastinoscopy • Sensitivity 85.2% • Specificity 100% • Complications • Death 1 • Esophageal perforation 1 • Pulmonary artery laceration 1 • Excessive bleeding 1 • Pneumothorax 1 • Hypotension 1 • IV fluid extravasation 1 • Arrhythmia 6 Hammoud et al. J ThoracCardiovascSurg 1999;118:894-9

  9. Mediastinoscopy for Staging Lung Cancer

  10. Adebibe, M et al. Interactive CardiovascThoracSurg 2012; 14:316-19

  11. Video Assisted Mediastinoscopy • Improved visualization • Better teaching • Higher lymph node yields • More lymph node stations Anraku, M et al. AnnThoracSurg 2010; 89:1577-81 Leschber, G et al. EJCTS 2008; 33:289

  12. Mediastinoscopy: An obsolete procedure • Inflammatory vs malignancy • Lymphoma • Small size nodes • Molecular profiling • Non-diagnostic EBUS • Training Rusch, V JTCVS 2011; 142:1400

  13. Mediastinoscopy vs. VATS Target location is paramount Detterbeck et al. Chest 2007; 132:202s

  14. Obiols, C et al. EJCTS 2012; 41:1043

  15. Extended Cervical Mediastinoscopy1998 – 2010 • Routine 89 • Selective 132 • Yield and safety profile do not compete with VATS Obiols, C et al. EJCTS 2012; 41:1043

  16. Re-do Mediastinoscopy

  17. Technical Details • Sharp dissection • Focus on target node • Needle aspiration for confirmation

  18. Indications • Inadequate prior mediastinoscopy • Obvious nodal target • No other minimally invasive option • i.e. VATS, Chamberlain, EBUS, EUS

More Related