Surgical Methods for Lung Cancer Staging

Abstract

A variety of surgical procedures can be used to determine tumor extension and nodal spread in patients with lung cancer. Mediastinoscopy, parasternal mediastinotomy, and extended cervical mediastinoscopy allow surgeons to assess the mediastinal extension of central tumors and to explore mediastinal nodes located in the paratracheal, anterior mediastinal, subaortic, and subcarinal stations. Remediastinoscopy is technically feasible in the evaluation of second primary and recurrent tumors and in the assessment of pathologic response after neoadjuvant chemotherapy. Scalene node biopsies can be performed with the help of the mediastinoscope; this is especially valuable in cases of N2 disease diagnosed at mediastinoscopy because subclinical N3 disease can be identified. Inferior mediastinoscopy is a complementary technique when low anterior mediastinal masses cannot be reached with other approaches. Pericardioscopy is useful to clarify the nature of pericardial effusion and to assess the invasion of the intrapericardial segments of pulmonary arteries and veins. Thoracoscopy and video-assisted thoracoscopic techniques are especially indicated to diagnose undetermined pleural effusions and ipsilateral or contralateral lung nodules; its systematic use before thoracotomy may reduce the exploratory thoracotomy rate. In addition to the value of inspection, all of these techniques allow one to perform biopsies and, therefore, they confer the highest classification certainty to the pre-thoracotomy clinical TNM classification. Journal of Bronchology7:254-259, 2000.