Mediastinal dissection. A multi-institutional assessment.

Mediastinal dissection was first described by George A. Sisson, MD, in 1962. However, there are no other reports in the literature describing the experience of other surgeons with this procedure. This study retrospectively analyzes the multi-institutional experience with mediastinal dissection to examine critically its effectiveness in controlling superior mediastinal neoplastic disease and to evaluate the complications of the procedure. This article describes 21 patients from three medical centers who have undergone mediastinal dissection by three surgeons for stomal recurrences. There are six patients who are free of disease for periods ranging from three months to six years postoperatively. Reconstructive techniques ranged from deltopectoral flap, gastric pull-up, or jejunal free grafts for esophageal reconstruction, myocutaneous flaps for tracheal reconstruction, to deltopectoral or thoracoacromial skin flaps for external resurfacing. This article also describes modifications designed to decrease mortality and to expedite the reconstruction, considering that this series suggests that mediastinal dissection probably should be considered as a palliative rather than curative attempt.