Surgical mediastinal staging in daily practice

• Published in: Lung cancer (Amsterdam, Netherlands) Vol. 47; no. 2; pp. 243 - 251
• Main Authors: Smulders, Sietske A., Smeenk, Frank W.J.M., Janssen-Heijnen, Maryska L.G., Wielders, Pascal L.M.L., de Munck, Dirk R.A.J., Postmus, Pieter E.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.02.2005; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Female; Hospitals, Teaching - standards; Hospitals, Teaching - statistics & numerical data; Humans; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Mediastinal lymph node metastases; Mediastinal lymph node sampling; Mediastinal Neoplasms - pathology; Mediastinoscopy; Medical sciences; Middle Aged; Neoplasm Staging - methods; Non-small cell lung cancer; Pneumology; Reproducibility of Results; Resection for lung cancer; Retrospective Studies; Sensitivity and Specificity; Staging guidelines; Surgical sampling; Thoracotomy; Tumors of the respiratory system and mediastinum; Upstaging; Upstaging; Resection for lung cancer; Non-small cell lung cancer; Staging guidelines; Mediastinal lymph node metastases; Surgical sampling; Mediastinoscopy; Mediastinal lymph node sampling; Resection; Mediastinum; Lung cancer; Samplings; Metastasis; non-small cell lung carcinoma; Daily; Surgery; Bronchus disease; Endoscopy; Sampling; Non small cell carcinoma; Lung disease; Lymph node; Respiratory disease; Malignant tumor; Recommendation; Medlastinal lymph node metastases; Treatment; Professional practice
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2004.06.017

An adequately staged mediastinum remains obligatory in patients with NSCLC prior to surgery. In this study, we investigated the accuracy of preoperative surgical mediastinal staging procedures in four hospitals. Non-university teaching hospital and three surrounding community hospitals in Eindhoven, The Netherlands. Patients with NSCLC who underwent mediastinoscopy and/or thoracotomy, between 1993 and 1999. Adherence to guidelines for indicating and performing mediastinoscopy were investigated and compared in four hospitals. Guidelines for indicating mediastinoscopy were adequately followed in two-thirds of cases. Mediastinoscopy was performed according to gold standards in 40% of cases. The hospital with the smallest number of evaluated patients scored the worst. Postoperatively, 17% of patients appeared to have “unforeseen N2–3 disease”. In approximately 18% of these “upstaged” patients, thoracotomy could have been prevented, if guidelines had been followed adequately. In clinical practice the adherence to staging guidelines with respect to mediastinoscopy is insufficient in one-third of patients. Furthermore, mediastinoscopy was performed according to gold standards in 40% of patients.