The role of mediastinoscopy and mediastinotomy in lung cancer.

Mediastinoscopy and mediastinotomy have a major role in patients with bronchogenic carcinoma. In some instances, they lead to a histologic diagnosis of a tumor of unknown cell type seen by chest roentgenogram, when other diagnostic methods have failed to do so. By far the most important role of these procedures is to stage the mediastinum for better selection of patients for surgery. Thoracotomy has a low morbidity and mortality; nevertheless, it is a formidable operation. If thoracotomy is used indiscriminately in patients with bronchogenic carcinoma who are referred for surgical treatment, many of these patients "lose, just through the operation, one or two of the best months they have left to live." In the five categories of patients described, mediastinoscopy and mediastinotomy are the most effective and economic methods for predicting who will benefit from thoracotomy and resection.