Annals of Surgical Oncology

, Volume 25, Issue 5, pp 1269–1276 | Cite as

Concomitant Mediastinoscopy Increases the Risk of Postoperative Pneumonia After Pulmonary Lobectomy

  • Sai Yendamuri
  • Athar Battoo
  • Kris Attwood
  • Samjot Singh Dhillon
  • Grace K. Dy
  • Mark Hennon
  • Anthony Picone
  • Chukwumere Nwogu
  • Todd Demmy
  • Elisabeth Dexter
Thoracic Oncology
  • 51 Downloads

Abstract

Background

Mediastinoscopy is considered the gold standard for preresectional staging of lung cancer. We sought to examine the effect of concomitant mediastinoscopy on postoperative pneumonia (POP) in patients undergoing lobectomy.

Methods

All patients in our institutional database (2008–2015) undergoing lobectomy who did not receive neoadjuvant therapy were included in our study. The relationship between mediastinoscopy and POP was examined using univariate (Chi square) and multivariate analyses (binary logistic regression). In order to validate our institutional findings, lobectomy data in the National Surgical Quality Improvement Program (NSQIP) from 2005 to 2014 were analyzed for these associations.

Results

Of 810 patients who underwent a lobectomy at our institution, 741 (91.5%) surgeries were performed by video-assisted thoracic surgery (VATS) and 487 (60.1%) patients underwent concomitant mediastinoscopy. Univariate analysis demonstrated an association between mediastinoscopy and POP in patients undergoing VATS [odds ratio (OR) 1.80; p = 0.003], but not open lobectomy. Multivariate analysis retained mediastinoscopy as a variable, although the relationship showed only a trend (OR 1.64; p = 0.1). In the NSQIP cohort (N = 12,562), concomitant mediastinoscopy was performed in 9.0% of patients, with 44.5% of all the lobectomies performed by VATS. Mediastinoscopy was associated with POP in patients having both open (OR1.69; p < 0.001) and VATS lobectomy (OR 1.72; p = 0.002). This effect remained in multivariate analysis in both the open and VATS lobectomy groups (OR 1.46, p = 0.003; and 1.53, p = 0.02, respectively).

Conclusions

Mediastinoscopy may be associated with an increased risk of POP after pulmonary lobectomy. This observation should be examined in other datasets as it potentially impacts preresectional staging algorithms for patients with lung cancer.

References

  1. 1.
    Carlens E. Mediastinoscopy: a method for inspection and tissue biopsy in the superior mediastinum. Dis Chest. 1959;36:343–52.CrossRefPubMedGoogle Scholar
  2. 2.
    Lemaire A, et al. Nine-year single center experience with cervical mediastinoscopy: complications and false negative rate. Ann Thorac Surg. 2006;82(4):1185–1189CrossRefPubMedGoogle Scholar
  3. 3.
    Cho JH, et al. A comparative analysis of video-assisted mediastinoscopy and conventional mediastinoscopy. Ann Thorac Surg. 2011;92(3):1007–1011.CrossRefPubMedGoogle Scholar
  4. 4.
    Roberts JR, Wadsworth J. Recurrent laryngeal nerve monitoring during mediastinoscopy: predictors of injury. Ann Thorac Surg. 2007;83(2):388–91CrossRefPubMedGoogle Scholar
  5. 5.
    Sandri A, et al. Major morbidity after video-assisted thoracic surgery lung resections: a comparison between the European Society of Thoracic Surgeons definition and the Thoracic Morbidity and Mortality system. J Thorac Dis. 2015;7(7):1174–180.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Samson P, et al. The National Surgical Quality Improvement Program risk calculator does not adequately stratify risk for patients with clinical stage I non-small cell lung cancer. J Thorac Cardiovasc Surg. 2016;151(3):697–705.CrossRefPubMedGoogle Scholar
  7. 7.
    Kent M, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg. 2014;97(1):236–42CrossRefPubMedGoogle Scholar
  8. 8.
    Lugg ST, et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax. 2016;71(2):171–76.CrossRefPubMedGoogle Scholar
  9. 9.
    Ben-David K, et al. Prospective Comprehensive Swallowing Evaluation of Minimally Invasive Esophagectomies with Cervical Anastomosis: Silent Versus Vocal Aspiration. J Gastrointest Surg. 2015;19(10):1748–752.CrossRefPubMedGoogle Scholar
  10. 10.
    Kim SJ, et al. Kinematic analysis of swallowing in the patients with esophagectomy for esophageal cancer. J Electromyogr Kinesiol. 2016;28:208–13.CrossRefPubMedGoogle Scholar
  11. 11.
    Zielinski M. Transcervical extended mediastinal lymphadenectomy. Thorac Surg Clin. 2010;20(2):215–23.CrossRefPubMedGoogle Scholar
  12. 12.
    Yendamuri S, Demmy TL. Is VAMLA/TEMLA the new standard of preresection staging of non-small cell lung cancer? J Thorac Cardiovasc Surg. 2012;144(3):S14–17.CrossRefPubMedGoogle Scholar
  13. 13.
    13. Witte B, et al. Combined videothoracoscopic and videomediastinoscopic approach improves radicality of minimally invasive mediastinal lymphadenectomy for early stage lung carcinoma. Eur J Cardiothorac Surg. 2009;35(2):343–47.CrossRefPubMedGoogle Scholar
  14. 14.
    Czarnecka K, Yasufuku K. The role of endobronchial ultrasound/esophageal ultrasound for evaluation of the mediastinum in lung cancer. Expert Rev Respir Med. 2014;8(6):763–76.CrossRefPubMedGoogle Scholar
  15. 15.
    Zielinski M, et al. Comparison of endobronchial ultrasound and/or endoesophageal ultrasound with transcervical extended mediastinal lymphadenectomy for staging and restaging of non-small-cell lung cancer. J Thorac Oncol. 2013;8(5):630–36.CrossRefPubMedGoogle Scholar
  16. 16.
    Yasufuku K, et al. A prospective controlled trial of endobronchial ultrasound-guided transbronchial needle aspiration compared with mediastinoscopy for mediastinal lymph node staging of lung cancer. J Thorac Cardiovasc Surg. 2011;142(6):1393–400.CrossRefPubMedGoogle Scholar
  17. 17.
    Oezkan F, et al. Efficient utilization of EBUS-TBNA samples for both diagnosis and molecular analyses. Onco Targets Ther. 2014;7:2061–65.PubMedPubMedCentralGoogle Scholar
  18. 18.
    De Leyn P, et al. Preoperative mediastinal lymph node staging for non-small cell lung cancer: 2014 update of the 2007 ESTS guidelines. Transl Lung Cancer Res. 2014;3(4):225–33.PubMedPubMedCentralGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Sai Yendamuri
    • 1
    • 2
  • Athar Battoo
    • 1
  • Kris Attwood
    • 3
  • Samjot Singh Dhillon
    • 4
  • Grace K. Dy
    • 4
  • Mark Hennon
    • 1
    • 2
  • Anthony Picone
    • 1
    • 2
  • Chukwumere Nwogu
    • 1
    • 2
  • Todd Demmy
    • 1
    • 2
  • Elisabeth Dexter
    • 1
    • 2
  1. 1.Department of Thoracic SurgeryRoswell Park Cancer InstituteBuffaloUSA
  2. 2.Department of SurgeryJacobs School of Medicine and Biomedical SciencesBuffaloUSA
  3. 3.Department of BiostatisticsRoswell Park Cancer InstituteBuffaloUSA
  4. 4.Department of MedicineRoswell Park Cancer InstituteBuffaloUSA

Personalised recommendations