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Surgical Endoscopy Jun 2022Mediastinoscopy was originally applied for lymph node biopsy and mediastinal tumor resection. Improved video imaging with spreadable working channels enabled... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Mediastinoscopy was originally applied for lymph node biopsy and mediastinal tumor resection. Improved video imaging with spreadable working channels enabled mediastinoscopy for inspection and tissue biopsy in the superior mediastinum but it is rarely used in minimally invasive esophageal cancer surgery. In this prospective trial, the practicability and security of spreadable video-assisted mediastinoscopic combined with laparoscopic transhiatal esophagectomy (VAME) with video-assisted thoracoscopic esophagectomy (VATE) were compared.
METHODS
A total of 200 eligible patients with esophageal squamous cell carcinoma were randomly divided into VAME or VATE groups. Early postoperative outcomes and lymph node dissection between the two groups were compared.
RESULTS
The operation time was significantly shorter (164.3 ± 47.0 min vs. 265.4 ± 47.2 min, P < 0.001), the number of dissected lymph nodes was less (15.8 ± 4.5 vs. 20.3 ± 6.5, P < 0.001), and the intraoperative blood loss was also significantly reduced (94.7 ± 56.7 mL vs. 184.4 ± 65.2 mL, P < 0.001) in the VAME compared to the VATE group, respectively. The incidence of pneumonia was lower (7% vs. 29%; P < 0.001) and the length of hospital stay was shorter in the VAME group compared to the VATE group (18.0 ± 7.6 days vs. 23.2 ± 7.2, P < 0.001, respectively). The chyle leak incidence appeared to be lower in the VAME group but statistical significance was not reached (1% vs. 4%; P = 0.369). There were no differences in the incidence of anastomotic leakages and recurrent laryngeal nerve paralysis between the groups. No 30-day mortality occurred in any of the cases.
CONCLUSION
VAME appears to be a practicable and secure method for esophagectomy but needs further proof of concept.
CLINICAL REGISTRATION NUMBER
Registered at Chinese Clinical Trial Registry, ChiCTR1900022797.
Topics: Esophageal Neoplasms; Esophageal Squamous Cell Carcinoma; Esophagectomy; Humans; Laparoscopy; Lymph Node Excision; Mediastinoscopy; Postoperative Complications; Prospective Studies; Retrospective Studies
PubMed: 34642798
DOI: 10.1007/s00464-021-08754-x -
Anticancer Research Feb 2022Pulmonary complications remain the most common problem following transthoracic esophagectomy. Minimally invasive approach has significantly improved clinical outcomes;... (Review)
Review
Pulmonary complications remain the most common problem following transthoracic esophagectomy. Minimally invasive approach has significantly improved clinical outcomes; however, respiratory distress is still significant. Minimally invasive transcervical esophagectomy with mediastinal lymphadenectomy avoids thoracic access, which may decrease pulmonary complications. Transcervical esophagectomy refers to transcervical esophageal mobilization and mediastinal lymphadenectomy followed by a transhiatal gastric and distal-esophageal mobilization, abdominal and lower mediastinal lymphadenectomy. Adoption of innovative minimally invasive techniques for the transcervical or transhiatal approach, such as laparoscopy or robotic-assisted mediastinoscopy have made possible transmediastinal approach for radical esophagectomy. This novel approach with avoidance of thoracotomy or thoracoscopy can omit one lung ventilation as in transthoracic esophagectomy. Patients with previous thoracic surgery, impaired respiratory system, and major comorbidities, who are unable to undergo transthoracic esophagectomy, become candidates for radical esophagectomy with promising results. Minimally invasive transcervical esophagectomy for esophageal cancer is a safe and feasible approach and may be a valuable alternative with promising clinical and oncological outcomes.
Topics: Esophageal Neoplasms; Esophagectomy; Humans; Lymph Node Excision; Mediastinoscopy; Mediastinum; Minimally Invasive Surgical Procedures; Robotic Surgical Procedures; Stomach; Treatment Outcome
PubMed: 35093866
DOI: 10.21873/anticanres.15526 -
South African Journal of Surgery.... Dec 2022Mediastinoscopy is an effective and safe diagnostic tool for anterior mediastinal lesions. The study was done to assess the usefulness of mediastinoscopy as a diagnostic...
BACKGROUND
Mediastinoscopy is an effective and safe diagnostic tool for anterior mediastinal lesions. The study was done to assess the usefulness of mediastinoscopy as a diagnostic modality for mediastinal lesions.
METHODS
A retrospective study of patients who had mediastinoscopy over 12 years at the Groote Schuur Hospital, Cape Town. Preoperative data, intraoperative and postoperative data were collected.
RESULTS
The records of 115 patients were reviewed. Male to female ratio was 1.4:1 with a mean age of 48.5 (± 16.8) years. Preoperative computerised tomography (CT) scan was done in 98.3%. The most common indications for mediastinoscopy were mediastinal lymphadenopathy (87.8%) and anterior mediastinal mass (12.2%). Prior endobronchial ultrasound (EBUS) biopsy was done in 11.3%. All the patients had conventional cervical mediastinoscopy. Lung cancer staging accounted for 16.5% of the procedures. A biopsy was successfully done in 103 patients (89.6%). The most common lymph node station biopsied was 2R (55.7% of 76 patients), though the information on stations biopsied could not be ascertained in 25.2% of patients. The complication rate was 1.7 % (suprasternal haematoma and brachiocephalic artery injury). Histopathologic diagnoses were obtained in 89.5% (103/115 patients). Benign diagnoses accounted for 72.8% (75), while malignant diagnoses were 27.2% (28). Intensive care unit (ICU) stay and mechanical ventilation were required in 5% and 2.5% of patients, respectively. The median postoperative hospital stay was 2 days. There were no postoperative deaths. The median follow-up period was 14 days.
CONCLUSION
Mediastinoscopy's diagnostic role is assured, still required and is safe with minimal morbidity and no mortality.
Topics: Humans; Female; Male; Middle Aged; Tertiary Care Centers; Retrospective Studies; South Africa
PubMed: 36477059
DOI: 10.17159/2078-5151/SAJS3735 -
BMC Gastroenterology Mar 2022Patients can present for a wide variety of etiologies for dysphagia, and it is important to consider less common causes once common etiologies have been ruled out....
BACKGROUND
Patients can present for a wide variety of etiologies for dysphagia, and it is important to consider less common causes once common etiologies have been ruled out. Extrapulmonary Mycobacterium tuberculosis (TB) presentations are rare to see in the western populations due to relative lack of TB exposure and overall less immunocompromised populations, but should be considered for at-risk patients. Gastrointestinal (GI) TB is rare, and the GI tract is considered only the sixth most frequent site of extrapulmonary TB (EPTB).
CASE PRESENTATION
This is a case report of a 35-year-old Ethiopian male presenting with dysphagia and retrosternal odynophagia who was found to have infiltration of mediastinal lymphadenopathy into the esophageal wall secondary to TB. This patient underwent an upper endoscopy, which revealed a linear 2 cm full thickness mucosal defect in the middle esophagus concerning for an infiltrative process with full thickness tear. Computed tomography (CT) of the chest demonstrated a subcarinal soft tissue mass that was inseparable from the esophagus. He was referred to thoracic surgery and underwent an exploratory mediastinal dissection. A mediastinoscopy scope was inserted and the mediastinal dissection was made until the subcarinal nodes were identified and removed. Biopsy results showed necrotizing and non-necrotizing granulomas, and acid-fast bacilli (AFB) culture from the surgically removed lymph node showed Mycobacterium TB complex growth. He had no known TB exposures and did not have any TB risk factors. He then followed up in infectious disease clinic and was managed with anti-tuberculosis treatment (ATT) with complete resolution of symptoms.
CONCLUSIONS
Our patient was ultimately found to have esophageal TB secondary to mediastinal invasion into the esophageal wall from lymphadenopathy associated with TB. This is an extremely rare presentation in western populations due to diminished exposure rates and overall less immunocompromised populations compared to impoverished countries with increased TB exposure and human immunodeficiency virus (HIV) infection rates. Although TB is not as commonly seen in western populations, it should be considered on the differential for any atypical presentations of GI diseases for patients with clinical or geographic risk factors.
Topics: Adult; Biopsy; Deglutition Disorders; Humans; Lymphadenopathy; Male; Tuberculosis, Gastrointestinal
PubMed: 35317747
DOI: 10.1186/s12876-022-02211-2 -
Journal of Clinical Oncology : Official... Aug 2023
Topics: Humans; Mediastinoscopy; Endosonography; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Neoplasm Staging; Lymph Nodes
PubMed: 37315288
DOI: 10.1200/JCO.23.00782 -
Medicina (Kaunas, Lithuania) Sep 2023: Treatment of advanced lung cancer (LC) has become increasingly personalized over the past decade due to an improved understanding of tumor molecular biology and... (Review)
Review
: Treatment of advanced lung cancer (LC) has become increasingly personalized over the past decade due to an improved understanding of tumor molecular biology and antitumor immunity. The main task of a pulmonologist oncologist is to establish a tumor diagnosis and, ideally, to confirm the stage of the disease with the least invasive technique possible. : The paper will summarize published reviews and original papers, as well as published clinical studies and case reports, which studied the role and compared the methods of invasive pulmonology diagnostics to obtain adequate tumor tissue samples for molecular analysis, thereby determining the most effective molecular treatments. : Bronchoscopy is often recommended as the initial diagnostic procedure for LC. If the tumor is endoscopically visible, the biopsy sample is susceptible to molecular testing, the same as tumor tissue samples obtained from surgical resection and mediastinoscopy. The use of new sampling methods, such as cryobiopsy for peripheral tumor lesions or cytoblock obtained by ultrasound-guided transbronchial needle aspiration (TBNA), enables obtaining adequate small biopsies and cytological samples for molecular testing, which have until recently been considered unsuitable for this type of analysis. During LC patients' treatment, resistance occurs due to changes in the mutational tumor status or pathohistological tumor type. Therefore, the repeated taking of liquid biopsies for molecular analysis or rebiopsy of tumor tissue for new pathohistological and molecular profiling has recently been mandated. : In thoracic oncology, preference should be given to the least invasive diagnostic procedure providing a sample for histology rather than for cytology. However, there is increasing evidence that, when properly processed, cytology samples can be sufficient for both the cancer diagnosis and molecular analyses. A good knowledge of diagnostic procedures is essential for LC diagnosing and treatment in the personalized therapy era.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Molecular Diagnostic Techniques
PubMed: 37893442
DOI: 10.3390/medicina59101723 -
Journal of Thoracic Disease Jan 2023
PubMed: 36794129
DOI: 10.21037/jtd-22-1420 -
Expert Review of Respiratory Medicine Sep 2019: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a low-invasive modality that shows excellent sensitivity, specificity, and accuracy in... (Review)
Review
: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a low-invasive modality that shows excellent sensitivity, specificity, and accuracy in the diagnosis of nodal metastasis of lung cancer. Thus, EBUS-TBNA has become the first choice for nodal staging of non-small cell lung cancer and an alternative to mediastinoscopy, which had long been the gold standard. EBUS-TBNA can be utilized not only for initial cancer staging but also for staging after treatment or for diagnostic purposes, including molecular diagnostics. Adequate specimens can be obtained by EBUS-TBNA for the molecular analysis of various genetic alterations and immunohistochemical analyses. The ultrasound technology utilized in EBUS keeps evolving, especially ultrasound imaging, which allows for adequate sampling of the most suspicious lesions. Minimally invasive chronological sampling allows for the evaluation of lesions molecularly or pathologically. : We discuss the current applications and future direction of EBUS-TBNA in this review. : EBUS-TBNA is an essential tool for evaluating patients since it obtains high-quality pathological samples with a low degree of invasiveness in the precision medicine era of lung cancer management.
Topics: Carcinoma, Non-Small-Cell Lung; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Lung Neoplasms; Neoplasm Staging; Reproducibility of Results
PubMed: 31322034
DOI: 10.1080/17476348.2019.1646642 -
Journal of the College of Physicians... Sep 2023To determine the yield of cervical mediastinoscopy in determining causes of mediastinal lymph node enlargement. (Observational Study)
Observational Study
OBJECTIVE
To determine the yield of cervical mediastinoscopy in determining causes of mediastinal lymph node enlargement.
STUDY DESIGN
Observational study. Place and Duration of the Study: CMH Rawalpindi, Lahore and Multan, from January 2010 to December 2021.
METHODOLOGY
Patients who underwent lymph node biopsy through cervical mediastinoscopy approach were included. Record of the patients including age, gender, clinical presentation, and findings on CT scan chest were noted along with the record of preoperative complications and duration of surgery. Histopathology report was also recorded.
RESULTS
Out of 398 patients, 259 (65%) were males and 139 (35%) were females. Out of 338 patients who were operated for diagnostic purpose, 157 (46%) had tuberculosis and 34 (10.1%) had sarcoidosis. Fifty-two (15.3%) were diagnosed to have malignancy including non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), and metastatic carcinoma of unspecified origin. Amongst staging group (n=60), 33 (55%) patients had negative mediastinal disease. Complication rate was 3.8%, including hoarseness of voice in three patients while 2 patients had wound infection requiring intervention.
CONCLUSION
Cervical mediastinoscopy is a safe and efficacious means of diagnosis in indeterminate mediastinal lymphadenopathy and staging of lung malignancy.
KEY WORDS
Mediastinoscopy, Lymph nodes, Tuberculosis, Lung cancer, Staging.
Topics: Female; Male; Humans; Mediastinoscopy; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Lymphadenopathy; Lymph Nodes
PubMed: 37691371
DOI: 10.29271/jcpsp.2023.09.1062 -
Asian Journal of Surgery Jun 2020The purpose of the study was to discuss the effectiveness of mediastinoscopy for pediatric patients as the use of EBUS-EUS (Endobronchial Ultrasound-Endoscopic...
BACKGROUND
The purpose of the study was to discuss the effectiveness of mediastinoscopy for pediatric patients as the use of EBUS-EUS (Endobronchial Ultrasound-Endoscopic Ultrasound) has replaced mediastinoscopy for adult patients in evaluation of the mediastinal area.
METHODS
The records of patients subject to cervical and anterior mediastinoscopy at our clinic from January 1, 2000 to June 1, 2019 were examined and patients aged 18 years or less were included in the study. Data were acquired on the demographic characteristics of the patients, type of surgery, complications, operation times, and histopathologic diagnoses.
RESULTS
Of the 1505 patients subject to intervention by mediastinoscopy at our clinic from January 1, 2000 to June 1, 2019, only 22 (1.46%) were pediatric patients aged 18 years or less. Cervical and anterior mediastinoscopies were performed on 16 and six patients, respectively. Histopathological tissue diagnoses via mediastinoscopy were obtained for 19 (86.3%) of 22 patients. The most frequently observed diagnoses were sarcoidosis (n = 10), lymphoma (n = 4), thymoma (n = 1), tuberculosis (n = 1), undifferentiated round cell sarcoma (n = 1), and reactive lymph node (n = 2); three patients could not be diagnosed. Mortality was not detected. There were no major complications requiring thoracotomy or sternotomy and none of the patients were subject to tube thoracostomy as a result of surgery.
CONCLUSION
Pediatric age mediastinoscopy may be the first method of diagnosis due to low complication rates and high diagnosis rates in mediastinal area.
Topics: Adolescent; Age Factors; Bronchoscopy; Child; Child, Preschool; Endosonography; Female; Humans; Lymphoma; Male; Mediastinoscopy; Pediatrics; Pseudolymphoma; Sarcoidosis; Sarcoma; Thymoma; Tuberculosis
PubMed: 31668417
DOI: 10.1016/j.asjsur.2019.09.012