The incidence of hoarseness after mediastinoscopy and outcome of video-assisted versus conventional mediastinoscopy in lung cancer staging*

Abstract

Objectives Theoretically, video-assisted mediastinoscopy (VM) should provide a decrease in the incidence of hoarseness in comparison with conventional mediastinoscopy (CM). Methods An investigation of 448 patients with the NSCLC who underwent mediastinoscopy (n = 261 VM, n = 187 CM) between 2006 and 2010. Results With VM, the mean number of sampled LNs and of stations per case were both significantly higher (n = 7.91 ± 1.97 and n = 4.29 ± 0.81) than they were for CM (n = 6.65 ± 1.79 and n = 4.14 ± 0.84) (p < 0.001 and p = 0.06). Hoarseness was reported in 24 patients (5.4%) with VM procedures resulting in a higher incidence of hoarseness than did CM procedures (6.9% and 3.2%) (p = 0.08). The incidence of hoarseness was observed to be more frequent in patients with left-lung carcinoma who had undergone a mediastinoscopy (p = 0.03). Hoarseness developed in 6% of the patients sampled at station 4L, whereas this ratio was 0% in patients who were not sampled at 4L (p = 0.07). A multivariate analysis showed that the presence of a tumor in the left lung is the only independent risk factor indicating hoarseness (p = 0.09). The sensitivity, NPV, and accuracy of VM were calculated as to be 0.87, 0.95, and 0.96, respectively. The same staging values for CM were 0.83, 0.94, and 0.95, respectively. Conclusion VM, the presence of a tumor in the left-lung, and 4L sampling via mediastinoscopy are risk factors for subsequent hoarseness. Probably due to a wider area of dissection, VM can lead to more frequent hoarseness.

Clinical updates of approaches for biopsy of pulmonary lesions based on systematic review

“…2b) which was reported to be 96% in recent years [37]. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of mediastinoscopy for the mediastinal staging of lung cancer were 82.83% ± 10.63%, 100%, 93.98% ± 4.68%, 100%, 87.64% ± 13.00%, respectively.…”

“…2d, hoarseness (67/4387:1.53%) was the top one complication following mediastinoscopy. Among the abovementioned 67 cases with hoarseness, nine cases (9/67) suffered from permanent hoarseness, two cases (2/67) recovered partially by vocal cord medialization and six cases (6/67) recovered within a few months [37–45]. Perioperative mortality was relatively low (4/2137: 0.19%).…”

Unforeseen N2 Disease after Negative Endosonography Findings with or without Confirmatory Mediastinoscopy in Resectable Non–Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

“…1). 5,[42][43][44][45][46][47][48] Unforeseen N2 Disease after EBUS and/or EUS as the Only Staging Technique A total of 31 studies or subgroups with use of endosonography only (without additional surgical staging) were included ( Fig. 2).…”

“…42,43,[45][46][47][48] The remaining eight studies included 1245 patients who underwent video mediastinoscopy for mediastinal staging of NSCLC. 5,[42][43][44][45][46][47][48] The median overall age was 63 years (range 55-68), and the median proportion of male patients was 82% (range 61-100). The eight studies included two randomized trials and one prospective and five retrospective observational studies with adequate definitions, retrieval, and reporting of complications.…”

“…All of the studies assessed at least the left and right paratracheal and the subcarinal lymph node stations, as recommended by the guideline. 2 The mean number of assessed lymph node stations ranged from 2.8 to 4.3, with a mean number of biopsied lymph nodes ranging from 7.0 to 12.0 (Table 1 5,[42][43][44][45][46][47][48] ). Four studies described more detailed information on the location of sampled lymph nodes.…”