Surgical experience and patient-related restrictions predict the adequacy of cervical mediastinoscopy in non-small cell lung carcinoma lymph node staging
Abstract Background Until recently, cervical mediastinoscopy was considered to be the reference standard for mediastinal staging for Non-Small Cell Lung Carcinoma (NSCLC). In the absence of metastases, mediastinal lymph node involvement is the most important prognostic factor and as such it determin...
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doaj-cabe8c340f8a4233bee59a78c102ca662020-11-25T01:08:10ZengBMCJournal of Cardiothoracic Surgery1749-80902018-12-011311610.1186/s13019-018-0821-7Surgical experience and patient-related restrictions predict the adequacy of cervical mediastinoscopy in non-small cell lung carcinoma lymph node stagingTheo J. Klinkenberg0Wobbe Bouma1Caroline Van De Wauwer2Rienhart F. E. Wolf3Massimo A. Mariani4Harry J. M. Groen5Department of Cardiothoracic Surgery, University of Groningen, University Medical Center GroningenDepartment of Cardiothoracic Surgery, University of Groningen, University Medical Center GroningenDepartment of Cardiothoracic Surgery, University of Groningen, University Medical Center GroningenDepartment of Cardiothoracic Surgery, University of Groningen, University Medical Center GroningenDepartment of Cardiothoracic Surgery, University of Groningen, University Medical Center GroningenDepartment of Pulmonary Diseases, University of Groningen, University Medical Center GroningenAbstract Background Until recently, cervical mediastinoscopy was considered to be the reference standard for mediastinal staging for Non-Small Cell Lung Carcinoma (NSCLC). In the absence of metastases, mediastinal lymph node involvement is the most important prognostic factor and as such it determines therapeutic strategies. In this study we evaluated the adequacy of cervical mediastinoscopy in NSCLC lymph node staging in a large university hospital over more than a decade. In addition, we determined the influence of: (1) surgeon’s experience (2) video-assisted mediastinoscopy (VAM) and (3) patient-related restrictions (PRR) on the adequacy of lymph node sampling. Methods Between January 2001 and December 2014, 225 patients underwent cervical mediastinoscopy for lymph node staging. Surgical and histological data were reviewed. Thirty-day follow-up was available for all patients. Lymph node sampling was considered adequate when stations 4 L, 4R and 7 were sampled (ESTS guidelines). A surgeon was considered to be experienced when he or she performed at least 40 procedures during the study-period. Results Intraoperative mortality was 0%. Thirty-day mortality was 1.3%. Overall adequacy of lymph node sampling was 56%. Univariate and multivariate logistic regression analyses of lymph node sampling adequacy revealed level of surgical experience and PRR as independent predictors of lymph node sampling adequacy. Conclusions Surgical experience and PRR independently predict the adequacy of cervical mediastinoscopy in NSCLC lymph node staging. VAM does not independently predict the adequacy of mediastinal lymph node sampling. In light of the expected further decline in mediastinoscopy numbers, we recommend to limit this procedure exclusively to the armamentarium of the experienced thoracic surgeon.http://link.springer.com/article/10.1186/s13019-018-0821-7MediastinoscopyVideo-assisted mediastinoscopyNon-small cell lung cancerExperience |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Theo J. Klinkenberg Wobbe Bouma Caroline Van De Wauwer Rienhart F. E. Wolf Massimo A. Mariani Harry J. M. Groen |
spellingShingle |
Theo J. Klinkenberg Wobbe Bouma Caroline Van De Wauwer Rienhart F. E. Wolf Massimo A. Mariani Harry J. M. Groen Surgical experience and patient-related restrictions predict the adequacy of cervical mediastinoscopy in non-small cell lung carcinoma lymph node staging Journal of Cardiothoracic Surgery Mediastinoscopy Video-assisted mediastinoscopy Non-small cell lung cancer Experience |
author_facet |
Theo J. Klinkenberg Wobbe Bouma Caroline Van De Wauwer Rienhart F. E. Wolf Massimo A. Mariani Harry J. M. Groen |
author_sort |
Theo J. Klinkenberg |
title |
Surgical experience and patient-related restrictions predict the adequacy of cervical mediastinoscopy in non-small cell lung carcinoma lymph node staging |
title_short |
Surgical experience and patient-related restrictions predict the adequacy of cervical mediastinoscopy in non-small cell lung carcinoma lymph node staging |
title_full |
Surgical experience and patient-related restrictions predict the adequacy of cervical mediastinoscopy in non-small cell lung carcinoma lymph node staging |
title_fullStr |
Surgical experience and patient-related restrictions predict the adequacy of cervical mediastinoscopy in non-small cell lung carcinoma lymph node staging |
title_full_unstemmed |
Surgical experience and patient-related restrictions predict the adequacy of cervical mediastinoscopy in non-small cell lung carcinoma lymph node staging |
title_sort |
surgical experience and patient-related restrictions predict the adequacy of cervical mediastinoscopy in non-small cell lung carcinoma lymph node staging |
publisher |
BMC |
series |
Journal of Cardiothoracic Surgery |
issn |
1749-8090 |
publishDate |
2018-12-01 |
description |
Abstract Background Until recently, cervical mediastinoscopy was considered to be the reference standard for mediastinal staging for Non-Small Cell Lung Carcinoma (NSCLC). In the absence of metastases, mediastinal lymph node involvement is the most important prognostic factor and as such it determines therapeutic strategies. In this study we evaluated the adequacy of cervical mediastinoscopy in NSCLC lymph node staging in a large university hospital over more than a decade. In addition, we determined the influence of: (1) surgeon’s experience (2) video-assisted mediastinoscopy (VAM) and (3) patient-related restrictions (PRR) on the adequacy of lymph node sampling. Methods Between January 2001 and December 2014, 225 patients underwent cervical mediastinoscopy for lymph node staging. Surgical and histological data were reviewed. Thirty-day follow-up was available for all patients. Lymph node sampling was considered adequate when stations 4 L, 4R and 7 were sampled (ESTS guidelines). A surgeon was considered to be experienced when he or she performed at least 40 procedures during the study-period. Results Intraoperative mortality was 0%. Thirty-day mortality was 1.3%. Overall adequacy of lymph node sampling was 56%. Univariate and multivariate logistic regression analyses of lymph node sampling adequacy revealed level of surgical experience and PRR as independent predictors of lymph node sampling adequacy. Conclusions Surgical experience and PRR independently predict the adequacy of cervical mediastinoscopy in NSCLC lymph node staging. VAM does not independently predict the adequacy of mediastinal lymph node sampling. In light of the expected further decline in mediastinoscopy numbers, we recommend to limit this procedure exclusively to the armamentarium of the experienced thoracic surgeon. |
topic |
Mediastinoscopy Video-assisted mediastinoscopy Non-small cell lung cancer Experience |
url |
http://link.springer.com/article/10.1186/s13019-018-0821-7 |
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