Thoracic Surgical Oncology, Dept of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
Multimed Man Cardiothorac Surg. 2021 Sep 30;2021. doi: 10.1510/mmcts.2021.055.
Mediastinal staging in potentially resectable non-small cell lung cancer is of paramount importance since it impacts the survival of the patient. With increasing nodal stage, survival was noted to precipitously decline. Nodal status also determined the use of neoadjuvant/adjuvant therapy and other treatment modalities. Various methods of obtaining lymphatic tissue from the mediastinum for staging purposes have been described in the literature, although mediastinoscopic lymph node evaluation remains the gold standard. Endoscopic methods of mediastinal staging, like the endobronchial ultrasound guided and esophageal ultrasound guided fine-needle aspiration techniques, although minimally invasive, provide the highest levels of accuracy when used in conjunction with surgical mediastinal staging. Video-assisted mediastinoscopic lymphadenectomy (VAMLA) provides clear advantages, as far as ergonomics and training are concerned, over conventional mediastinoscopy. Access to stations 2R, 2L, 4R, 4L, and 7 is feasible with VAMLA. In this video vignette, we present the step-by-step technique of a standard VAMLA, with an overview of relevant anatomical relationships, for the effective and safe clearance of lymph node stations for the purposes of staging and defining appropriate therapy.
纵隔分期对可切除的非小细胞肺癌至关重要，因为它会影响患者的生存。随着淋巴结分期的增加，生存率显著下降。淋巴结状态还决定了新辅助/辅助治疗和其他治疗方式的应用。文献中描述了多种从纵隔获取淋巴组织进行分期的方法，尽管纵隔镜淋巴结评估仍然是金标准。内镜纵隔分期方法，如支气管内超声引导和食管超声引导细针抽吸技术，虽然微创，但与外科纵隔分期联合使用时提供了最高水平的准确性。与传统纵隔镜相比，视频辅助纵隔镜淋巴结切除术 (VAMLA) 在操作和培训方面具有明显优势。VAMLA 可以进入 2R、2L、4R、4L 和 7 站。在这个视频片段中，我们展示了标准 VAMLA 的分步技术，概述了相关的解剖关系，以有效和安全地清除淋巴结站，用于分期和确定适当的治疗。
