A Comparative Analysis of Video-Assisted Mediastinoscopy and Conventional Mediastinoscopy

Background. The objective of this study was to compare outcomes of video-assisted mediastinoscopic lymph node biopsy in patients with non-small cell lung cancer (NSCLC) with outcomes of conventional mediastinoscopic lymph node biopsy in this same patient population. Methods. All mediastinoscopies at one medical center from January 2008 to December 2009 were analyzed. Numbers of lymph nodes dissected, stations biopsied, remnant lymph nodes when major lung resection was performed after mediastinoscopic lymph node biopsy, and complications were recorded. Results. Of 521 mediastinoscopies, 222 were in the conventional mediastinoscopic lymph node biopsy group (CM group) and 299 were in the video-assisted mediastinoscopic lymph node biopsy group (VAM group). Eleven complications (2.11%) occurred, with more occurring in the CM group (3.6%) than in the VAM group (1.6%; p = 0.030). The total number of dissected nodes was higher in the VAM group (mean, 8.53 +/- 5.8) than in the CM group (mean, 7.13 +/- 4.9; p = 0.004), and there was no statistically significant difference between the average number of stations sampled in the CM group (2.98 +/- 0.7) and in the VAM group (3.06 +/- 0.75; p = not significant). The number of remnant lymph nodes when major lung surgery was performed after mediastinoscopy was lower in the VAM group (mean, 5.05 +/- 4.5) than in the CM group (mean, 7.67 +/- 6.5; p < 0.001). Conclusions. This study found that video-assisted mediastinoscopic lymph node biopsy had fewer complications than did the conventional method. More lymph nodes were examined and fewer lymph nodes remained after mediastinoscopy by video-assisted mediastinoscopy (VAM) than by conventional mediastinoscopy. (Ann Thorac Surg 2011;92:1007-11) (C) 2011 by The Society of Thoracic Surgeons