A survey analysis of thoracic surgeons in Turkey on mediastinal investigation of lung cancer.

A total of 59 general thoracic surgeons of 21 academically based thoracic surgery centres in Turkey were surveyed to identify the attitudes toward mediastinal investigations in patients with lung cancer. The surgeons were asked 16 questions in five separate groups by survey questionnaire. Analyses of the replies were as follows: Group I: 37 (62.7%) of the respondents were working in 11 centres where > 100 patients are admitted or referred for lung cancer annually. More than 50 thoracotomies are performed for lung cancer annually in one third of the centres in which 28 (47.5%) respondents work. Group II: Among the diagnostic methods for evaluating mediastinum, surgeons most commonly used the computed tomography, mediastinoscopy, mediastinotomy and scalene lymph node biopsy. Invasive staging was done routinely by ten (16.9%) and selectively by 44 (74.6%). Group III: In patients with preoperatively histologically proven ipsilateral mediastinal lymph node involvement, 39 (66.1%) were advocates of operating. When the lymph node(s) was found to be positive at operation, 33 of them (55.9%) gave the decision with respect to the number, size and presence of pericapsular invasion of the node(s), while 24 (40.7%) decided to perform lung resection in every situation. Group IV: All accessible mediastinal nodes were said to be removed at thoracotomy by 37 (62.7%). Group V: Currently available methods for mediastinal investigation were found to be partially sufficient by 37 (62.7%). The most important factor in predicting postoperative survival was selected as nodal status by 27 (45.8%). It is noticed that nearly all thoracic surgeons in Turkey perform mediastinal investigation preoperatively in patients with lung cancer, however, the impact of lymph node status needs to be more commonly appreciated.