Is video-assisted mediastinoscopy superior than standard mediastinoscopy for mediastinal staging of the patients with lung cancer?

Background: In this study, we aimed to compare standard mediastinoscopy (SM) with video-assisted mediastinoscopy (VAM) for mediastinal staging of the patients with lung cancer in terms of safety profile, complication rates, mediastinal station, and lymph node counts. Methods: Data of 551 patients who were admitted to our clinic between January 2006 and January 2011 with the diagnosis of non-small cell lung cancer (NSCLC) and were scheduled for surgery were retrospectively analyzed. Age and sex of the patients and cell type of the tumor were recorded. A total of 361 patients (65.5%) had SM, while 190 patients (34.5%) had VAM. Results: Of the patients, 63.2% (n=96) who underwent VAM and 70.1% (n=218) who underwent SM were diagnosed with squamous cell carcinoma. N-2 nodal involvement was detected in 66 of 361 patients (18.3%) who underwent SM and 60 of 190 patients (31.6%) who underwent VAM (p<0.001). Sensitivity was 87% and 79% at VAM and SM, respectively. Major hemorrhage was observed in four patients (1.1%) during SM, while none of the patients in the VAM group experienced such complication (p=0.3). Conclusion: Our study results suggest that VAM is a safe and invaluable method to be used in preoperative mediastinal staging of the patients with lung cancer. We believe that the main superiority of VAM over SM is the prevention of hemorrhage.