Mediastinoscopy in Bronchogenic Cancer

¹ Surgical Department, University of Amsterdam, Wilhelmina Gasthuis

It is stated that mediastinal extension is the cause of nonresectability in a high percentage of cases during exploratory thoracotomy in bronchogenic cancer. Mediastinoscopy is a method of proving this mediastinal extension before thoracotomy. In this article, the results are mentioned of 122 consecutive mediastinoscopies performed on patients with cancer of the lung, with no evidence of non-resectability. In this series, there were 45 patients (36.9 per cent) with tumor bearing tissue in the biopsy specimen. After selection by mediastinoscopy, the resection rate rose to more than 90 per cent.

The patients with so-called positive mediastinoscopy were thought to be incurable. The considerations applying to the judgment as to incurability of these patients are mentioned.

It is stated that mediastinoscopy should be performed when there is no evidence of incurability and when the patients correspond to one of the following criteria:

1. Central lesions on the x-ray film.

2. Diffuse, poorly demarcated lesions or atelectasis on the x-ray film.

3. Oat cell carcinoma.

4. Dubiously operable patients.

Every lymph node metastasis gives a more widespread dissemination of tumor. This is the reason that in 22 per cent of cases, contralateral lymph node metastases were found, right-sided as well as left-sided.

In cases of right-sided incurable lung cancer with hypertrophic osteoarthropathy, vagotomy on the right side is possible through the mediastinoscope.