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Accuracy and survival of repeat mediastinoscopy after induction therapy for non-small cell lung cancer in a combined series of 104 patients

^a Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
^b Department of Thoracic Surgery, Hospital Mútua de Terrassa, Plaza Dr. Robert 5, 08221 Terrassa, Spain

Received 13 September 2007; received in revised form 5 February 2008; accepted 6 February 2008.

^_* Corresponding author. Tel.: +32 3 8214360; fax: +32 3 8214396. (Email: mizzie{at}skynet.be).

Objective: Precise restaging of non-small cell lung cancer after induction therapy is of utmost importance. Remediastinoscopy remains a controversial procedure. In a combined, updated series of two thoracic centres, accuracy and survival of remediastinoscopy were determined. Methods: From November 1994 to August 2005, remediastinoscopy was performed in 104 patients (98 men, 6 women) after induction therapy for locally advanced non-small cell lung cancer. Mean age was 64.3 years (range 38–85). Neoadjuvant chemotherapy was given in 79 patients and chemoradiotherapy in 25. Follow-up data were completed in January 2007. Results: Remediastinoscopy was technically feasible in all patients except for one who died due to perioperative haemorrhage. Remediastinoscopy was positive in 40 patients and negative in 64; the latter group underwent thoracotomy. There were 17 false-negative remediastinoscopies. Sensitivity of remediastinoscopy was 71%, specificity 100% and accuracy 84%. Follow-up was complete for all patients. Sixty-nine died, mostly of distant metastases. Median survival time for the whole group was 18 months (95% confidence interval 11–25). Median survival time in patients with a positive remediastinoscopy was 14 months (95% confidence interval 8–20), with a negative remediastinoscopy 28 months (95% confidence interval 15–41) and with a false-negative remediastinoscopy 24 months (95% confidence interval 3–45). In univariate analysis the difference between positive and negative remediastinoscopies was highly significant (p = 0.001). In a multivariate analysis including sex, age, histology, centre, and nodal status at remediastinoscopy, only nodal status was a significant independent prognostic factor (p = 0.008). Conclusions: Remediastinoscopy is a valuable restaging procedure after induction therapy. Persisting mediastinal nodal involvement proven at remediastinoscopy heralds a poor prognosis.

Key Words: Remediastinoscopy • Lung cancer • Staging • Induction therapy

This article has been cited by other articles:

				P. E. Van Schil, M. De Waele, and R. Rami-Porta Reply to De Leyn and Lerut. Mediastinoscopy and repeat mediastinoscopy: still useful tools in experienced hands! Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 709 - 710. [Full Text] [PDF]

				P. De Leyn and T. Lerut Reply to Van Schil and Stamatis Remediastinoscopy: a dangerous tool? Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 708 - 709. [Full Text] [PDF]