Value of Video-Assisted Mediastinal Lymphadenectomy in Mediastinal Staging in Non-Small-Cell Lung Cancer Patients.

OBJECTIVES

Mediastinal lymph node staging is essential in the management of patients with non-small-cell lung cancer. According to the guideline of the European Society of Thoracic Surgery, invasive staging should be performed in selected patients. The outcome of invasive staging with video-assisted mediastinoscopic lymphadenectomy in patients with potentially respectable non-small-cell lung cancer is evaluated in this study.

METHODS

Patients who underwent invasive mediastinal staging by video-assisted mediastinoscopic lymphadenectomy between 2008 and 2019 received retrospective single-centre analysis. Patients were divided into 2 groups: one group met the guideline criteria for invasive staging, whereas the other group did not.

RESULTS

A total of 1640 patients were included in the study, 374 (22.8%) of whom had mediastinal lymph node metastases. N2 and N3 status were detected in 300 (18.2%) and 74 (4.5%) patients, respectively. The complication rate for the procedure was 4.8% (n = 79). False negative results were detected in 5 patients (2.2%). For the entire cohort, the sensitivity, specificity, negative predictive value, and accuracy were 98.68% (95% CI, 96.95%-99.57%), 100% (95% CI, 99.65%-100%), 99.53 (95% CI, 98.88%-99.8%), and 99.65% (95% CI, 99.19%-99.89%), respectively. In the guideline accordant-group, mediastinal metastases were detected in 370 out of 1463 cases (25.3%), whereas in the other-group, metastases were found in 4 out of 177 cases (2.3%), (P < .001).

CONCLUSIONS

Video-assisted mediastinoscopic lymphadenectomy is a safe procedure with high sensitivity, specificity, negative predictive value, and accuracy. The guideline criteria for selecting patients who should be considered for invasive mediastinal staging are valid.

CLINICAL REGISTRATION NUMBER: Ethics committee of Medical Association Westphalia Lippe (2021-049-f-S).