Mediastinoscopy in superior vena cava obstruction: analysis of 80 consecutive patients

Background. Prejudices against mediastinoscopy in superior vena cava obstruction still remain. Hereby we analyze risk/benefit balance in a large series of patients. Methods. Eighty consecutive patients underwent cervical mediastinoscopy for caval obstruction, 51 after uncertain diagnosis obtained by lesser techniques, 17 after ineffective chemotherapy (n = 9) or radiotherapy (n = 8). In 12 patients we immediately performed mediastinoscopy as an urgent procedure. In addition the examination was combined with left anterior mediastinotomy (n = 7) for staging purposes. Results. No perioperative mortality was recorded. Five patients had significant bleeding, but only one required sternotomy. Definitive diagnosis was obtained in all patients: 50 lung cancer, 17 lymphoma, 7 invasive thymoma, 3 postradiation fibrosis, 2 metastatic lymph nodes from renal carcinoma, and 1 fibrosing mediastinitis. Specific therapy had excellent effects in 71 patients, negligible in 7, and adverse in 2. Postmediastinoscopy brachial venous pressure had a mean significant decrease (p< 0.0001). Lung cancer was the sole variable significantly associated with unfavorable outcome (p< 0.0004). Conclusions. Mediastinoscopy should be routinely included after less invasive procedures in the diagnostic program because it is simple, low risk, and effective.