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Cervical Mediastinoscopy and Anterior Mediastinotomy in Superior Vena Cava Obstruction^*

^* From the Second Department of Propedeutic Surgery, Division of Thoracic Surgery Athens University School of Medicine (Dr. Dosios); and Division of Thoracic Surgery, Henry Dunant Hospital, Athens, Greece (Dr. Theakos).

Correspondence to: Theodosios Dosios, MD, Second Department of Propedeutic Surgery, Division of Thoracic Surgery Athens University School of Medicine, 2 Chatzigianni Mexi Str, 11528, Athens, Greece; e-mail: dosiosth{at}internet.gr

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.

Key Words: airway obstruction • anterior mediastinotomy • biopsy • cervical mediastinoscopy • hemorrhage • superior vena cava obstruction