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Habiba Hashimi, David T Cooke, Elizabeth A David, Lisa M Brown
Accurate staging for non-small cell lung cancer (NSCLC) is essential to guide therapy. While computed tomography (CT) and positron emission tomography (PET) scan can indicate whether mediastinal lymphadenopathy is present, histologic confirmation is required to complete the staging evaluation. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique associated with similar diagnostic yield and improved postoperative pain and complication rates compared to mediastinoscopy...
2018: Journal of Visualized Surgery
Jun Wang, Ning Wei, Yimin Lu, Xiaoying Zhang, Nanqing Jiang
BACKGROUND: We aimed to compare mediastinoscopy-assisted esophagectomy (MAE) with the Ivor Lewis procedure in T2 middle and lower thoracic esophageal carcinoma patients in fields of perioperative complications and overall survival (OS). METHODS: The clinical data of 112 T2 esophageal cancer patients who received MAE (n = 31) or Ivor Lewis procedure (n = 81) from January 2010 to December 2015 were retrospectively analyzed in propensity score analysis. Thirty-eight T2 esophageal cancer patients who underwent MAE (n = 19) and Ivor Lewis procedure (n = 19) were included in this study...
March 16, 2018: World Journal of Surgical Oncology
Prudence Dy, Cristina Lajom, Josephino Sanchez
Neurogenic tumours of the mediastinum in adults occur most often at the posterior mediastinum, majority of which are benign of nerve sheath in origin. A 72-year-old woman, known asthmatic, presented with chronic symptoms of hoarseness, dysphagia, chest heaviness, easy fatigability, cough, epigastric pain, feeling of abdominal fullness and choking with food intake and at a supine position. Treated for other disorders, routine chest X-ray incidentally found a homogenous convex radiodensity at the right paratracheal area; mass which was also observed with CT and 18F-fludeoxyglucose-positron emission tomography/CT scan studies...
March 13, 2018: BMJ Case Reports
Lucas W Thornblade, Douglas E Wood, Michael S Mulligan, Alexander S Farivar, Michal Hubka, Kimberly E Costas, Bahirathan Krishnadasan, Farhood Farjah
OBJECTIVE: Prior studies have reported underuse of-but not variability in-invasive mediastinal staging in the pretreatment evaluation of patients with lung cancer. We sought to compare rates of invasive mediastinal staging for lung cancer across hospitals participating in a regional quality improvement and research collaborative. METHODS: We conducted a retrospective study (2011-2013) of patients undergoing resected lung cancer from the Surgical Clinical Outcomes and Assessment Program in Washington State...
February 9, 2018: Journal of Thoracic and Cardiovascular Surgery
Yuanshan Yao, Yinjie Zhou, Zhenhua Yang, Hongbo Huang, Haibo Shen
The purpose of this study was to determine the effects of resection coupled with standard chemotherapy on survival prognosis of patients with early-stage small cell lung carcinoma (SCLC). Patients (n=110) with mediastinal lymph node-negative SCLC were enrolled in this study. The baseline clinical data of patients with surgery was retrospectively reviewed. Overall and progression-free survival were measured by Kaplan-Meier and log-rank test analyses. Ninety-eight patients received mediastinoscopy biopsy and pulmonary lobectomy or sublobar resection, and 67 patients underwent adjuvant chemotherapy after pulmonary lobectomy...
March 9, 2018: Oncology Research
João Bruno Ribeiro Machado Lisboa, Guilherme de Abreu Rodrigues, Diego Corsetti Mondadori, João Paulo Cassiano de Macedo, Orival De Freitas Filho, Paulo Manuel Pêgo-Fernades
The diagnosis and treatment of tuberculosis (TB) in transplanted receivers presents several challenges. TB is an opportunistic infection with high morbidity and mortality in solid organs of transplanted patients, therefore, the diagnosis difficulties. A case of a 30-year-old male, heart transplanted patient, who after being submitted to mediastinoscopy, obtained a result of lymph node TB.
January 2018: International Journal of Mycobacteriology
Sai Yendamuri, Athar Battoo, Kris Attwood, Samjot Singh Dhillon, Grace K Dy, Mark Hennon, Anthony Picone, Chukwumere Nwogu, Todd Demmy, Elisabeth Dexter
BACKGROUND: Mediastinoscopy is considered the gold standard for preresectional staging of lung cancer. We sought to examine the effect of concomitant mediastinoscopy on postoperative pneumonia (POP) in patients undergoing lobectomy. METHODS: All patients in our institutional database (2008-2015) undergoing lobectomy who did not receive neoadjuvant therapy were included in our study. The relationship between mediastinoscopy and POP was examined using univariate (Chi square) and multivariate analyses (binary logistic regression)...
February 27, 2018: Annals of Surgical Oncology
Waseem Hajjar, Iftikhar Ahmed, Samiha Aljetaily, Tarfah Al-Obaidan, Adnan W Hajjar
Diagnosing endobronchial tuberculosis (EBTB) can be difficult due to the lack of specific signs and symptoms that differentiate it from other respiratory diseases, such as lung tumors. We hereby report a case of a very rare presentation of tuberculosis (TB) in a patient who presented with a dry cough and significant weight loss for 3 months. Chest X-ray and CT scan of the chest showed partial atelectasis and a segmental collapse of the right upper lobe and tumor-like arising from its bronchus along with a large right para-tracheal mediastinal lymphadenopathy, mimicking a metastatic (N2) disease...
March 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Baihua Zhang, Junliang Ma, Xinjian Yan, Xu Li, Qin Xiao, Wenxiang Wang, Yong Zhou
RATIONALE: Minimally invasive esophagectomy (MIE) have been increasingly used and are regarded as suitable alternatives to open esophagectomy. However, few previous reports described minimally invasive esophagectomy using a left-sided approach. PATIENT CONCERNS AND DIAGNOSES: A 71-year-old man was admitted to our hospital because of progressive dysphagia. Synchronous double primary thoracic esophageal and left lung cancers were considered before the operation. INTERVENTIONS AND OUTCOMES: A lobectomy and MIE, via a left video-assisted thoracoscopic approach, was performed...
January 2018: Medicine (Baltimore)
David Jonathan Heineman, Naomi Beck, Michael Wilhelmus Wouters, Thomas Jan van Brakel, Johannes Marlene Daniels, Wilhelmina Hendrika Schreurs, Chris Dickhoff
OBJECTIVE: Optimal treatment selection for patients with non-small cell lung cancer (NSCLC) depends on the clinical stage of the disease. Particularly patients with mediastinal lymph node involvement (stage IIIA-N2) should be identified since they generally do not benefit from upfront surgery. Although the standardized preoperative use of PET-CT, EUS/EBUS and/or mediastinoscopy identifies most patients with mediastinal lymph node metastasis, a proportion of these patients is only diagnosed after surgery...
January 9, 2018: European Journal of Surgical Oncology
Juan Carlos Trujillo-Reyes, Elisabeth Martínez-Téllez, Ramón Rami-Porta, Carme Obiols, Sergi Call, Josep Belda-Sanchis
Surgical staging of lung and pleural cancers is crucial for planning treatment and assessing prognosis. In some cases, we need to explore both the mediastinum and the pleural cavity to confirm or rule out tumor dissemination. The combination of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and thoracoscopy through a single transcervical incision allows the surgeon to widen the range of the exploration and improve the staging for lung and pleural cancers.  VAMLA consists of complete removal of the mediastinal fat and lymph nodes of the subcarinal space, the right paratracheal and pretracheal areas, and the left paratracheal space...
January 18, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Catalina Lizama, Neli S Slavova-Azmanova, Martin Phillips, Michelle L Trevenen, Ian W Li, Claire E Johnson
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and guide sheath (EBUS-GS) are gaining popularity for diagnosis and staging of lung cancer compared to CT-guided transthoracic needle aspiration (CT-TTNA), blind fiber-optic bronchoscopy, and mediastinoscopy. This paper aimed to examine predictors of higher costs for diagnosing and staging lung cancer, and to assess the effect of EBUS techniques on hospital cost. MATERIAL AND METHODS Hospital costs for diagnosis and staging of new primary lung cancer patients presenting in 2007-2008 and 2010-2011 were reviewed retrospectively...
January 29, 2018: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Wenxiang Wang, Baihua Zhang, Xu Li, Jie Wu, Zhining Wu, Yan Ding, Desong Yang, Jinming Tang, Min Su, Junliang Ma, Xianman You, Jianping Liang, Yong Zhou
Objective: Minimally invasive esophagectomy (MIE) is increasingly used for the treatment of esophageal cancer. However, MIE via the Sweet approach has seldom been reported owing to the challenging procedure for a mediastinal lymph node. Thus, the approach of MIE via left-sided thoracoscopy coupled with video-assisted cervical mediastinoscopy (MIE-SM) was explored for eradicating the mediastinal lymph nodes and recurrent laryngeal nerve; the incidence of perioperative complications, mortality, and surgical radicality were analyzed...
December 2017: International Journal of Surgery. Oncology
Benoît Fréchet, Jordan Kazakov, Vicky Thiffault, Pasquale Ferraro, Moishe Liberman
BACKGROUND: Nonsmall cell lung cancer (NSCLC) treatment is based on an accurate staging. Mediastinal lymph nodes staging has a critical impact on treatment management. METHODS: The objective was to assess the current accuracy of preoperative tools for predicting mediastinal and hilar lymph nodes staging with NSCLC. Retrospective analysis of 997 biopsy-proven NSCLC patients treated at a single academic medical center between January 2006 and April 2012. Mediastinal lymph nodes were evaluated with preoperatively with: computed tomography (CT), positron emission tomography (PET), endobronchial ultrasound-guided fine needle aspiration, and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA)...
January 2018: Journal of Bronchology & Interventional Pulmonology
D Pandey, P Ramanathan, R Pandey, K Prabhash
Mediastinal staging is a crucial factor in the decision making in patients with non-metastatic non-small cell lung cancer (NSCLC). Mediastinoscopy has historically been the gold standard for this purpose. With the advent of PET-CT, the role of an invasive staging modality like mediastinoscopy has been diminishing. Newer developments in endoscopic staging like EBUS and EUS-FNA have also provided means to get a cytological diagnosis of enlarged lymph nodes. With the meta-analyses showing encouraging results of neoadjuvant chemotherapy in operable lung cancers including the early stage disease, the sanctity of invasive mediastinal staging for the sole purpose for selecting patients for upfront surgery is debatable...
January 2017: Indian Journal of Cancer
J P Cata, J Lasala, G E Mena, J R Mehran
Tumor staging is critical for the treatment of lung malignancies. Invasive techniques of lung tumor staging can be accomplished via mediastinoscopy, endobronchial ultrasound, and video-assisted thoracoscopy. Anesthesiologists taking care of patients undergoing mediastinal staging procedures might face different challenges. In this narrative review, the authors summarize the literature on the anesthetic considerations for mediastinal staging procedures.
September 21, 2017: Journal of Cardiothoracic and Vascular Anesthesia
Monica Sigovan, Pia Akl, Caroline Mesmann, Francois Tronc, Salim Si Mohamed, Philippe Douek, Loic Boussel
OBJECTIVE: To evaluate the accuracy of diffusion weighted MRI with background suppression (DWIBS) in differentiating between malignant and benign mediastinal lymph-nodes. METHODS: Consecutive patients with enlarged mediastinal lymph-nodes underwent MRI DWIBS within 10 days prior to mediastinoscopy. Relative contrast ratios (RCR) were computed on b800 and apparent diffusion coefficient (ADC) maps by dividing the node signal with the chest muscle signal, using manually drawn regions of interest (ROIs) by radiologists, blinded to pathology...
November 10, 2017: British Journal of Radiology
Akif Turna, Hüseyin Melek, H Volkan Kara, Burcu Kılıç, Ezel Erşen, Kamil Kaynak
OBJECTIVE: The European Society of Thoracic Surgeons (ESTS) has proposed a revised preoperative lymph node staging guideline for patients with potentially resectable non-small cell lung cancer (NSCLC). We aimed to assess the validity of this revised ESTS guideline and survival results in our patient cohort. METHODS: A total of 571 patients with potentially resectable NSCLC seen between January 2004 and November 2013 were included in the study. The preoperative mediastinal staging was performed by video-assisted cervical mediastinoscopy or video-assisted mediastinoscopic lymphadenectomy in all patients except those with peripheral cT1N0 nonadenocarcinoma tumors...
February 2018: Journal of Thoracic and Cardiovascular Surgery
Kyle H Cichos, Paul L Linsky, Benjamin Wei, Douglas J Minnich, Robert J Cerfolio
BACKGROUND: Our objective is to show the effect that standardization of surgical trays has on the number of instruments sterilized and on cost. METHODS: We reviewed our most commonly used surgical trays with the 3 general thoracic surgeons in our division and agreed upon the least number of surgical instruments needed for mediastinoscopy, video-assisted thoracoscopic surgery, robotic thoracic surgery, and thoracotomy. RESULTS: We removed 59 of 79 instruments (75%) from the mediastinoscopy tray, 45 of 73 (62%) from the video-assisted thoracoscopic surgery tray, 51 of 84 (61%) from the robotic tray, and 50 of 113 (44%) from the thoracotomy tray...
December 2017: Annals of Thoracic Surgery
Yuyang Zhang, Yolanda Elam, Patricia Hall, Hadyn Williams, Darko Pucar, Vijay Patel
With nonsmall cell lung cancer (NSCLC), accurate mediastinal nodal staging is crucial to determine whether a patient is or is not a surgical candidate. Traditionally, computed tomography (CT) and fluorodeoxy-D-glucose (FDG) positron emission tomography (PET)/CT are the initial steps followed by tissue sampling through mediastinoscopy and/or thoracotomy, which are invasive procedures. There is controversy regarding the possibility of omission of the invasive diagnostic procedures and solely relying on noninvasive presurgical staging CT and FDG PET/CT results...
October 2017: World Journal of Nuclear Medicine
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