The new case for cervical mediastinoscopy in selection for radical surgery for malignant pleural mesothelioma

From a prospective database, we identified 212 patients with non-sarcomatoid malignant pleural mesothelioma

A. Nakas

2012

Scholarcy highlights

  • The relative post-operative prognostic importance of extrapleural lymph node metastases remains undetermined
  • We investigated the effect of nodal burden and distribution in survival by testing for differences between N0, N1 and N2 disease and constructing a theoretical model dividing the patients into four groups according to diseased nodes identified in the surgical specimen: Group 0, no nodal disease; Group CM, nodes accessible by cervical mediastinoscopy: Stations 2, 3a, 4 and 7; Group endobronchial ultrasound/endoscopic ultrasound, nodes accessible by endobronchial or endoscopic ultrasound: Stations 2, 3a, 4 and 7–11
  • Subgroup analysis of patients with nodal metastases revealed no significant survival difference between group CM and group EBUS/EUS: achieving maximum theoretical diagnostic yield CM could detect 63 of patients with nodal disease and the median survival of this group was 13.6 months
  • EBUS/EUS could detect an additional 30 cases with survival of 11.3 months
  • The survival in group EM was significantly better than groups CM or EBUS/EUS, P = 0.002
  • There was no difference in survival between extrapleural pneumonectoctomy and lung-sparing total pleurectomy, P = 0.41
  • In light of the findings of this study, we must consider whether the benefits of lung-sparing surgery in upper mediastinal nodal disease justify the attendant risks or whether non-surgical treatment is preferable

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