The value of cervical mediastinoscopy combined with anterior mediastinotomy in the peroperative evaluation of bronchogenic carcinoma of the left upper lobe.

METHODS: From January 1990 to July 1994, 85 patients who were otherwise thought to have an operable tumour within the left upper lobe underwent left anterior mediastinotomy supplemented by cervical mediastinoscopy in 75 cases. This combined approach allowed assessment of nodal involvement within the superior and anterior mediastinal areas, the detection of direct tumour invasion into the mediastinum and the determination of resectability by bidigital examination of the area around the aortic arch and sub-aortic fossa.

RESULTS: It was found that 27 (31.8%) patients were inoperable, either because of nodal involvement at cervical mediastinoscopy (4 patients) or because of extension into the mediastinum at left anterior mediastinotomy (14 patients), or because of positive results from both methods (9 patients). The inoperability determined by this examination for patients with adenocarcinoma (8/18, 44.4%) is higher than for patients with squamous carcinoma (12/52, 23.1%). All of the 58 patients with negative findings proceeded to thoracotomy and complete resection was possible in 54 patients (93.1%).

CONCLUSION: We conclude that this combined approach is better than using either technique alone in the preoperative staging and the evaluation of resectability of left upper lobe tumours.