The value of cervical mediastinoscopy combined with anterior mediastinotomy in the peroperative evaluation of bronchogenic carcinoma of the left upper lobe

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Abstract
METHODS: From January 1990 to July 1994, 85 patients who were otherwisethought to have an operable tumour within the left upper lobe underwentleft anterior mediastinotomy supplemented by cervical mediastinoscopy in 75cases. This combined approach allowed assessment of nodal involvementwithin the superior and anterior mediastinal areas, the detection of directtumour invasion into the mediastinum and the determination of resectabilityby bidigital examination of the area around the aortic arch and sub-aorticfossa. RESULTS: It was found that 27 (31.8%) patients were inoperable,either because of nodal involvement at cervical mediastinoscopy (4patients) or because of extension into the mediastinum at left anteriormediastinotomy (14 patients), or because of positive results from bothmethods (9 patients). The inoperability determined by this examination forpatients with adenocarcinoma (8/18, 44.4%) is higher than for patients withsquamous carcinoma (12/52, 23.1%). All of the 58 patients with negativefindings proceeded to thoracotomy and complete resection was possible in 54patients (93.1%). CONCLUSION: We conclude that this combined approach isbetter than using either technique alone in the preoperative staging andthe evaluation of resectability of left upper lobe tumours.

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