Positive Mediastinoscopy: An Ominous Finding

Abstract The attrition rate of 75 patients with bronchogenic carcinoma and positive mediastinal lymph node biopsies was greater than 90% at 2 years. In addition to routine pulmonary function studies, 17 patients with positive ipsilateral intranodal metastases were further studied by right heart catheterization, unilateral pulmonary artery balloon occlusion, global and selective pulmonary arteriograms, ventilation and perfusion scintiphotography, single-breath carbon monoxide diffusing capacity, and calculation of Q s /Q t and V d /V t ratios. Fifteen of these 17 patients underwent thoracotomy; 11 had unresectable disease and died within 12 months, and the remaining 4 underwent radical pneumonectomy with 1 operative death. Irradiation to the mediastinum was given to the 3 survivors, but all died within 24 months. Fifty-nine patients who had negative mediastinoscopies underwent thoracotomy; the lesions in 19 (32.2%) were unresectable, and all were dead within 18 months. The survival rate in the 40 patients undergoing either pneumonectomy [11] or lobectomy [29] remains discouraging and not dissimilar from series in which the patients did not have mediastinoscopy. There were 4 operative deaths (10%); 24 are dead of their disease (60%), and of the 12 survivors 6 have known recurrence. Thus only 6 patients (2 who had pneumonectomy and 4 who had lobectomy), representing 15% of those undergoing resection, remain eligible for consideration as 5-year survivors. Mediastinoscopy is now employed in the evaluation of all patients with bronchogenic carcinoma; abnormal findings are regarded as a contraindication to subsequent thoracotomy. Of the 75 patients who had positive mediastinoscopies, only 1 survived beyond 3 years.