Menon Ashvini, Milton Richard, Thorpe James Andrew Charles, Papagiannopoulos Kostas
St James University Hospital, Leeds, United Kingdom.
Eur J Cardiothorac Surg. 2007 Aug;32(2):351-4; discussion 354-5. doi: 10.1016/j.ejcts.2007.04.031. Epub 2007 May 23.
To assess the role of video-assisted mediastinoscopy (VAM) in identifying involved mediastinal lymph nodes in patients undergoing pulmonary metastasectomy.
Over a 4-year period (2002-2005) a retrospective study was carried out in 57 patients (44 men, 13 women, mean age 59 years) undergoing isolated, unilateral or bilateral metastasectomy. Following staging CT scan, VAM was performed prior to open thoracotomy, median sternotomy or VATS resection of the metastasis. Follow-up was complete in all patients.
Fifty-seven patients underwent 62 operations for metastatic disease. The majority had colorectal cancer (39) followed by renal (11), sarcoma (9), liver (2) and miscellaneous (8). Six patients (10.5%) had positive mediastinal nodes on VAM. There was no perioperative morbidity or mortality. At a median follow-up of 25 months, 63 patients (68.5%) were still alive.
Mediastinal lymph node involvement has been reported to occur in up to 14% of patients with pulmonary metastasis. In our study, 10% of patients treated for pulmonary metastasis had positive nodal disease at metastasectomy. We believe our results confirm that VAM can be safely performed and may have a role in more accurate staging of metastatic disease and influence the decision for post-resection adjuvant therapy.
评估电视辅助纵隔镜检查（VAM）在接受肺转移瘤切除术患者中识别受累纵隔淋巴结的作用。
在4年期间（2002 - 2005年），对57例患者（44例男性，13例女性，平均年龄59岁）进行了一项回顾性研究，这些患者接受了孤立性、单侧或双侧转移瘤切除术。在进行分期CT扫描后，在开胸手术、正中开胸或VATS切除转移瘤之前进行VAM。所有患者均完成随访。
57例患者接受了62次转移性疾病手术。大多数患者患有结直肠癌（39例），其次是肾癌（11例）、肉瘤（9例）、肝癌（2例）和其他（8例）。6例患者（10.5%）VAM检查发现纵隔淋巴结阳性。无围手术期发病率或死亡率。中位随访25个月时，63例患者（68.5%）仍存活。
据报道，高达14%的肺转移患者会出现纵隔淋巴结受累。在我们的研究中，10%接受肺转移治疗的患者在转移瘤切除术中发现淋巴结阳性疾病。我们认为我们的结果证实VAM可以安全进行，并且可能在更准确地分期转移性疾病以及影响切除后辅助治疗的决策方面发挥作用。
