Introduction: Mediastinoscopy is an important tool for staging lung cancer and evaluating mediastinal pathology. The objective of this retrospective study was to investigate the indications and safety of mediastinoscopy in a well defined cohort of patients. 

Material and methods: All patients that underwent mediastinoscopy in Iceland between 1983-2007 were included. Clinical information was obtained from patient charts and pathology reports rewied. The study-period was divided into 5-year periods for comparison,

Results: Altogether 278 operations were performed but in 17 cases data was missing, leaving 261 patients for analysis (mean age 59 yrs, range 11-89, 159 males). A steady increase was seen in the number of operations, or from 16 to 85 during the first and last periods, respectively (p<0.01). Staging of lung cancer (61,3%), evaluation of mediastinal tumors (24,5%), and suspected sarcoidosis (8,8%) were the most common indications. Mean operating time was 30 minutes (range 10-320) and median hospital stay 1 day (range 0,5-26). The most common histological diagnosis were nonspecific changes (33,6%), lung cancer (23,8%) and sarcoidosis (12,7%). Seven patients (2.7%) had complications; including 4 (1.5%) with hoarsness due to left recurrent nerve injury, one (0,3%) with pneumothorax and two with >500 ml hemorrhage (1.1%). There were two operative deaths (< 30 days), one due to major intraoperative bleeding.

Conclusions: The number of mediastinoscopies is increasing in Iceland, especially as a part of lung cancer staging. Mediastinoscopy is a safe procedure with low mortality and morbidity, where a specific diagnosis is obtained in most cases.

Figure 1.  Mediastinal lymph node stations. Based on Naruke and slightly modified.


Table I. Post operative complications following 261 mediastinoscopies performed in Iceland between 1983-2007. Patients can have more than one complication. Number of patients, % in parenthesis


Number of patients  261  
Males   159 (60.9)   
Average age, yrs (range)  59 (11-89)  
        
Complication   Number (%, n/261)   
Hoarseness   4(1,5)   
Pneumothorax   1(0,3)   
Infection   1(0,3)   
Bleeding   3(1,1)   
        
Total number of complications  7(2,7)   
Operative Mortality (< 30 days)  2(0,76)  


Table II. Comparison of key studies regarding  the surgical outcome of mediastinoscopy, including  the rate of complications and surgical deaths (< 30 days).
 
 
Author (year)   Number of patients  Complications %   Surgical deaths %   
Luke et al. (1986) 22   1000   2,3  0   
Puhakka et al.(1987) 19   2021  2,3   0   
Cybulshky et al. (1994) 21   1015  1,4   0   
Hammoud et al. (1999) 2   2137  0,6   0,2   
Urschel et al. (2000) 20   324  -   0,3   
Lemaire et al. (2006) 8   2145  1,1   0,05   
Olafsdottir et al. (2009)   261  2,7   0,8