Diagnostic value of video-mediastinoscopy for thoracic diseases

Abstract

Objective To investigate the diagnostic value and learning curve of video-mediastinoscopy(VMS) for thoracic diseases. Methods Clinical data of 111 patients undergoing VMS in the same operative group in the department of thoracic surgery from January 2009 to June 2018 were retrospectively analyzed. Among them, 96 patients with mediastinal lymphadenopathy were divided into groups A, B, C and D according to the sequence of operation, 24 in each group. The learning curve of VMS was calculated according to the amount of bleeding, operative time, perioperative morbidities, postoperative hospital stay, etc. Results Among 111 cases of VMS, only 4 cases of mediastinal lymphadenopathy were not diagnosed clearly after operation, and the diagnostic rate of VMS was 96.4% (107/111). 8 cases of pleural effusion and 7 cases of mediastinal tumors were definitely diagnosed.The overall incidence of surgical complications was 9.0%, including 1 case of intraoperative bleeding from arteriae anonyma, 1 case of transient recurrent laryngeal nerve paralysis, 7 cases of delayed healing of incision, and 1 case of postoperative death from massive hemoptysis due to advanced lung cancer (0.9%). After mediastinal staging in 60 patients with lung cancer, 54 patients found mediastinal lymph node metastasis, and 6 negative patients were confirmed by radical resection. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of VMS were all 100% for mediastinal staging in lung cancer. In terms of bleeding volume, group A (26.3±32.9) ml and group B (34.1±101.6) ml were significantly more than group C (6.6±10.0) ml and group D (8.6±9.4) ml. The differences between the four groups were statistically significant (P=0.004). However, there was no significant difference in operative time, perioperative morbidities and postoperative hospital stay(P>0.05). Conclusions VMS is safe, minimally invasive and reliable in staging lung cancer and diagnosis of thoracic diseases. Its learning curve for mediastinal lymph node biopsy is about 24-48 cases for clinicians. Key words: Video-mediastinoscope; Thoracic diseases; Mediastinal lymph node; Learning curve