Combined cervical and left parasternal mediastinoscopy for pre-operative staging of left upper lobe lung cancer.

Since exploratory thoracotomy, incomplete and palliative resection do not in effect prolong life expectancy, it is essential to determine the operability of a lung tumor as accurately as possible. Cervical mediastinoscopy has dropped the percentage of exploratory thoracotomy considerably. However, the lymph nodes in the periaortic region cannot be reached at cervical mediastinoscopy and these form an important lymph drainage pathway for the left upper lobe. The periaortic lymph nodes can be explored by left parasternal mediastinoscopy. In the present study we investigate the value of combined cervical and left parasternal mediastinoscopy in all patients with a clinically operable central lung cancer in the left upper lobe, and in patients with a peripheral cancer of the left upper lobe, when the tumor histology is unfavourable, or when there is suspicion of invasion of the surrounding organs. In the retrospective group, we found metastases at cervical mediastinoscopy in 12.9% of the patients with a tumor of the left upper lobe. In the prospective group, we found metastases at cervical mediastinoscopy, in 41.9% of the patients with a tumor of the left upper lobe. All the patients with a positive mediastinoscopy were excluded from operation. In those cases the lymph nodes were involved, or at multiple localizations, or at one localization extranodulary. The number of exploratory thoracotomies dropped in the prospective period and the resectability increased from 79.4% to 96.5% for the left upper lobe. These data point to the reliability of left parasternal mediastinoscopy combined with the cervical mediastinoscopy in the assessment of the operability of the left upper lobe lung cancer, in order to avoid unnecessary thoracotomies.