Ruolo della mediastinoscopia e della video toracoscopia per la diagnosi e la stadiazione delle patologie neoplastiche toraco-mediastiniche


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Federico Attene, Fabrizio Scognamillo, Andreas Xidas, Fernando Serventi, Mario Trignano

Ann. Ital. Chir., 2009; 80: 17-24

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staging of coin lesion of the lung and of mediastinal masses.
MATERIALS AND METHODS: 72 patients, 55 males and 17 females, affected by lung coin lesion without any previous
histological diagnosis have been admitted to our Institution from 1997 to 2007. Mean age was 59.4 for males (range
29-82) and 57.2 for females (range 14-79).
RESULTS: Mediastinoscopy resulted to be diagnostic in 95% of cases. In just one case mediastinoscopy failed and video
assisted thoracoscopy was performed, which permitted to obtain diagnosis. Video assisted thoracoscopy was able to lead to
diagnosis in 98.1% of cases, as we observed only one failure. In this single case we converted the thoracoscopic approach
to open, but although the convertion it was not possible to make diagnosis.
DISCUSSION: In these ten years, thanks to adequate indication for mediastinoscopy and video assisted thoracoscopy, the
use of thoracotomy for diagnosis and staging of pulmonary neoplastic diseases has been reduced: thus we avoided 80%
of unnecessary thoracotomies in patients affected by not resectable lung cancer, metastases (treated by atypical thoracoscopic
resection) or benign diseases.
CONCLUSION: The minimally ìnvasive surgical exploration of mediastinum and thoracic cavity allows to obtain all necessary
informations (in terms of histology and staging) to programme an adequate therapeutic protocol, reducing postoperative
pain and hospital stay, in comparison to thoracotomy.