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Vol. 41. Issue 3.
Pages 125-129 (March 2005)
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Vol. 41. Issue 3.
Pages 125-129 (March 2005)
Original Article
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Importance of Routine Mediastinal Staging in Women With Nonsmall Cell Lung Cancer
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J.L. Martín de Nicolás, A. Gómez-Caro Andrés
Corresponding author
abelitov@yahoo.es
ablgomez@hotmail.com

Correspondence: Dr. A. Gómez-Caro Andrés. Servicio de Cirugía Torácica. Hospital Universitario 12 de Octubre. Ctra. de Andalucía, km 5,400. Madrid. España
, F.J. Moradiellos Díez, V. Díaz-Hellín, O. Gigirey Castro, E. Larrú Cabrero, J.A. Pérez Antón, C. Marrón Fernández
Servicio de Cirugía Torácica, Hospital Universitario 12 de Octubre, Madrid, Spain
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Objective

TO study the specific importance of mediastinal staging in women with nonsmall cell lung cancer.

Patients and methods

Between July 1981 and September 2003 we surgically staged 2172 patients with nonsmall cell lung cancer who met the inclusion criteria for resectability and operability. A subgroup of 108 women was studied. Cervical mediastinoscopy was performed in all cases, with the addition of anterior mediastinotomy in cases with left upper lobe involvement. All patients underwent a preoperative computed tomography chest scan.

Results

Cervical mediastinoscopy was performed on all 108 patients, 26 of whom also underwent anterior mediastinotomy. Positive findings were recorded in 44 (40.7%) of the 108 cases: 39 of the 108 mediastinoscopies (36.1%), 9 of the 26 mediastinotomies (34.6%), and in 5 cases (19.2%) both mediastinoscopy and mediastinotomy. Nodal involvement was found in 13% of cases in clinical stage IA and 30.8% of cases in clinical stage IB. The percentage of positive findings was significantly higher for cases with adenocarcinoma or large cell carcinoma (P <.05). We performed 67 thoracotomies: 46 patients underwent lobectomy (42.6% of the 108), 7 bilobectomy (6.5%), 9 pneumonectomy (8.3%), and 5 exploratory thoracotomy (4.6%). The agreement between clinical staging after mediastinoscopy and pathological staging after thoracotomy was 47% (stage IA) and 57% (stage IB).

Conclusions

Routine mediastinoscopy is indicated for all women with nonsmall cell lung cancer, regardless of clinical stage.

Key Words:
Mediastinoscopy
Women
Sex
Bronchogenic carcinoma
Objetivo

Investigar la importancia específica de la estadificación mediastínica de mujeres con carcinoma broncogénico, no microcítico.

Pacientes Y Métodos

Entre julio de 1981 y septiembre de 2003 estadificamos quirúrgicamente a 2.172 pacientes con carcinoma broncogénico no microcítico que cumplían criterios de resecabilidad y operabilidad. Se realizó medias-tinoscopia cervical de forma habitual, y mediastinotomía anterior en caso de afectación del lóbulo superior izquierdo. Todos los pacientes tenían una tomografía axial computari-zada de tórax preoperatoria. Se estudió al subgrupo de 108 mujeres.

Resultados

Realizamos mediastinoscopia cervical en 108 casos y mediastinotomía anterior en 26. Fueron positivas 44 (40,7%) -39 (36,1%) mediastinoscopias, 9 (34,6%) mediastinotomías y en 5 (19,2%) casos ambas—. Se objetivó afectación ganglionar en un 13% de los casos en estadio IA y en un 30,8% en estadio IB. El porcentaje de positivi-dad fue significativamente mayor en caso de adenocarcinoma o carcinoma de células grandes (p < 0,05). Realizamos 67 toracotomías: 46 (42,6%) lobectomías, 7 (6,5%) bilobectomías, 9 (8,3%) neumonectomías y 5 (4,6%) toracotomías exploradoras. La concordancia entre estadificación clínica posmediastinoscopia y patológica postoracotomía fue del 47% (IA) y del 57% (IB).

Conclusiones

La mediastinoscopia sistemática está indi-cada en todas las mujeres con carcinoma broncogénico no microcítico independientemente del estadio clínico.

Palabras clave:
Mediastinoscopia
Mujeres
Sexo
Carcinoma broncogénico
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This article was presented at the Third International Workshop on Surgical Exploration of the Mediastinum and Systematic Nodal Dissection, held in Terrassa, Barcelona, Spain, in November, 2003.

Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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