Combined video-assisted mediastinoscopy and video-assisted thoracoscopy inthe management of lung cancer

Background. This study seeks to assess the safety and usefulness of combine d video-assisted mediastinoscopy and video-assisted thoracoscopy in the man agement of patients with lung cancer. Methods. Ten consecutive patients with lung neoplasms were evaluated. Indic ations for this combined approach included inconclusive findings from imagi ng techniques concerning locoregional extension and resectability; possible involvement of different structures not accessible to a single procedure; and failure to obtain histologic diagnosis by a single technique. Results. Histologic diagnosis was obtained in 6 patients without preoperati ve histologic typing. In 3 patients, in contrast with preoperative imaging studies, combined thoracoscopy and mediastinoscopy showed the resectability of the primary tumor and the absence of metastatic mediastinal lymph nodes . These findings were confirmed at thoracotomy. In 3 other patients prevasc ular lymph nodes metastases were found. They underwent neoadjuvant chemothe rapy; at subsequent operation, a complete resection was possible. In the re maining four cases combined exploration proved definitive contraindications for operation (recognition of oat-cell carcinoma, n = 2; T4 status, n = 1; T3N2, n = 1). Conclusions. Combined video-assisted mediastinoscopy and video-assisted tho racoscopy seems to be a safe and useful tool in the management of selected patients with lung neoplasms. Both the extent of primary tumor and the poss ible intrathoracic spread may be exhaustively evaluated. In patients with l eft lung cancer a complete exploration of the aortopulmonary window is poss ible. (C) 2001 by The Society of Thoracic Surgeons.