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Eur J Cardiothorac Surg 2005;27:384-390
© 2005 Elsevier Science NL

Transcervical extended mediastinal lymphadenectomy—the new operative technique and early results in lung cancer staging

Jarosaw Kuda^a,*, Marcin Zieliski^a, Bolesaw Papla^b, Artur Szlubowski^a, ukasz Hauer^a, Tomasz Nabiaek^a, Witold Sonicki^a, Juliusz Pankowski^c

^a Department of Thoracic Surgery, Pulmonary Hospital Zakopane, ul. Gadkie 1, 34-500 Zakopane, Poland
^b Chair and Department of Clinical and Experimental Pathology, Jagiellonian University, Cracow, Poland
^c Department of Pathology, Pulmonary Hospital Zakopane, Zakopane, Poland

Received 15 September 2004; received in revised form 27 November 2004; accepted 6 December 2004.

^* Corresponding author. Tel.: +48 600 815664; fax: +48 18 20 14632. (E-mail: j.kuzdzal{at}mp.pl).

Objective: Mediastinal staging is one of the most important problems in thoracic surgery. Although the pathological examination is a generally accepted standard, none of the currently used techniques enables complete removal of all lymph node stations of the mediastinum. The aim of the study is to present a new technique of transcervical extended mediastinal lymphadenctomy (TEMLA) and to analyze its value in lung cancer staging. Methods: In the prospective study of consecutive group of non-small cell lung cancer (NSCLC) patients, operated on between January and August 2004, we evaluated the usefulness of this original technique of bilateral mediastinal lymphadenectomy, assessing its accuracy and safety. The operations were performed through the transcervical approach, were videomediastinoscopy-assisted, with sternum elevation. Lymph node stations 1, 2R, 2L, 3a, 4R, 4L, 5, 6, 7 and 8 were removed. In patients without mediastinal metastases thoracotomy with pulmonary resection was performed and mediastinum searched for any missed lymph nodes. Results: There were 83 patients operated on with the TEMLA technique. The mean number of nodes removed was 43 (range: 26–85). The sensitivity, specificity and accuracy of the presented method in detecting mediastinal node metastases were: 90, 100, and 96%, respectively, whereas the positive and negative predictive values were: 100 and 95%, respectively. Conclusions: The TEMLA technique is a safe and highly accurate method of mediastinal staging in NSCLC.

Key Words: Non-small cell lung carcinoma • Lymph node excision • Mediastinum • Neoplasm staging

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