Search

Between January 1974 and December 1996 we performed exploratory surgery (mediastinoscopies/mediastinotomies) on 1,618 patients diagnosed of bronchogenic carcinoma who were considered functionally operable and whose cancer was believed to be resectable. Findings were positive in 26%. Thirty-four (2.1%) complications were encountered, with a significantly higher incidence of complication among those for whom the results of exploratory surgery were positive (p = 0.004) as follows: only 13 cases (0.8%) of significant bleeding; 12 cases (0.74%) of recurrent left nerve palsy (0.74%), 4 (0.25%) subcutaneous wound infections; 3 cases (0.18%) of pneumothorax; 1 (0.06%) perforated esophagus; and 1 case (0.06%) of chylomediastinum. The rate of morbidity associated with exploratory surgery was within the range reported in the literature. No deaths occurred. Mediastinoscopy, in our experience, is the most effective way of staging mediastinal ganglia. Provided the procedure is performed carefully by experienced surgeons, the risk of complication is minimal.

We evaluate surgical risk and efficacy in a series of 29 patients referred to us over a 22-year period with diagnoses of superior vena cava syndrome (SVCS) requiring surgical removal of histology specimens. We did 34 procedures: 23 mediastinoscopies, 6 mediastinotomies, 2 thoracotomies, 2 sternotomies and 1 Daniel's biopsy procedure. Mean surgical time was 88 minutes. There were no serious surgical complications and no deaths. Histological diagnoses (27 malignant and 2 benign) were obtained for all patients. The efficacy of mediastinoscopy was 82.6% whereas the efficacy of mediastinotomy was 66.6%. We believe that diagnostic surgical procedures in patients with SVCS are safe and effective. The use of blind radiation therapy is unjustified, given that some patients present benign processes or malignant ones that are more responsive to chemotherapy. Moreover, subsequent histologic confirmation can be made more difficult after blind radiation.