TECHNICAL NOTES   

Minerva Chirurgica 2006 April;61(2):177-80

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: English

Extended bilateral mediastinal dissection via a limited thoracotomy for right-lung cancer

Infante M. ¹, Cariboni U. ¹, Alloisio M. ¹, Testori A. ¹, Cioffi U. ², Bottoni E. ¹, Incarbone M. ¹, Ravasi G. ¹

¹ Unit of Thoracic Surgery Humanitas Hospital Rozzano, Milan, Italy 2 Department of Surgery Ospedale Maggiore Policlinico Fondazione IRCCS, Milan, Italy

In non small cell lung cancer (NSCLC) patients undergoing surgery after induction chemotherapy, all mediastinal lymphnodes potentially involved by tumor should be resected whenever possible. Paratracheal bilateral lymphadenectomy for left sided tumors can be disabling, i.e. median sternotomy plus a thoracotomy to reach the subcarinal region. From the right side, an extensive ipsilateral dissection is feasible through a standard thoracotomy, but contralateral lymphnodes, especially in the left hilum and aortopulmonary window are considered inaccessible. A technical tip is shown to reach and dissect the left paratracheal and aortopulmonary window nodes through a simple right thoracotomy in right-lung cancer. The procedure has been carried out in 3 cases and proved to be technically feasible. The value of such a procedure as to staging accuracy, local disease control and survival should be evaluated in a clinical trial setting.