The use of anterior mediastinotomy to assess intrathoracic lesions.

A ten-year experience (1970-1979) with 164 anterior mediastinotomies at a VA hospital to diagnose pulmonary or mediastinal lesions or to assess the resectability of carcinoma of the lung is reported. of 135 attempts to obtain diagnosis, 130 (96%) were successful. Of 19 patients who had a subsequent thoracotomy because the anterior mediastinotomy suggested that a curative resection was possible, 17 (90%) had successful resections. Two (1.7%) patients died-one of a paraneoplastic syndrome and one from progressive respiratory failure. Eleven complications in the 162 survivors included eight minor wound infections, an initially unrecognized pneumothorax, persistent bleeding from a lymph node biopsy site, and an air leak necessitating reoperation in another. Anterior mediastinotomy is a relatively safe procedure, even in patients with advanced carcinoma or lung disease. it has much less risks than a formal thoracotomy and provides much better exposure and diagnostic possibilities than a mediastinoscopy.