Is there a role for routine mediastinoscopy in patients with peripheral T1lung cancers?

BACKGROUND: The role of surgical staging of patients with non-small cell lu ng cancer (NSCLC) continues to evolve. This report describes our findings u tilizing routine cervical mediastinoscopy in the evaluation of peripheral T 1 (<3 cm) lung tumors. METHODS: Retrospectively 30 patients with peripheral T1 lesions and CT scan s negative for pathologic adenopathy were identified over a 3-year period. Cervical mediastinoscopy was performed prior to VATS/thoracotomy during the same operative session. RESULTS: Mediastinoscopy was performed in 29 of 30 patients. For patients w ith malignancy (27 of 30), 3 of 27 (11%) had mediastinoscopy positive for m alignancy and no further resection performed. Overall the subgroup of patie nts with bronchogenic carcinomas had positive mediastinal involvement ident ified in 5 of 24 (21%) after mediastinoscopy or complete resection. CONCLUSIONS: A significant number of patients with small peripheral lung ca ncers harbor radiographically occult lymph node involvement. Mediastinoscop y facilitates identification of patients with regionally advanced disease p rior to resection, allowing neoadjuvant therapy and avoiding unnecessary re sections. (C) 2001 by Excerpta Medica, Inc.