новая папка / Operative Standards for Cancer Surgery Volume I 1st Edition

REFERENCES

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2.De Leyn P, Lardinois D, Van Schil PE, et al. ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardiothorac Surg 2007;32(1):1-8.

3.Cornwell LD, Bakaeen FG, Lan CK, et al. Endobronchial ultrasonography-guided transbronchial needle aspiration biopsy for preoperative nodal staging of lung cancer in a veteran population. JAMA Surg 2013;148(11):1024-1029.

4.Herth FJ, Eberhardt R, Krasnik M, et al. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. Chest 2008;133(4):887-891.

5.Herth FJ, Ernst A, Eberhardt R, et al. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum. Eur Respir J 2006;28(5): 910-914.

6.Hwangbo B, Kim SK, Lee HS, et al. Application of endobronchial ultrasound-guided transbronchial needle aspiration following integrated PET/CT in mediastinal staging of potentially operable non-small cell lung cancer. Chest 2009;135(5):1280-1287.

7.Lee HS, Lee GK, Lee HS, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal staging of nonsmall cell lung cancer: how many aspirations per target lymph node station? Chest 2008;134(2):368-374.

8.Yasufuku K, Pierre A, Darling G, 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):1393-1400.

9.Feller-Kopman D, Yung RC, Burroughs F, et al. Cytology of endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective study with histology correlation. Cancer 2009; 117(6):482-490.

10.Ømark Petersen H, Eckardt J, Hakami A, et al. The value of mediastinal staging with endobronchial ultrasound-guided transbronchial needle aspiration in patients with lung cancer. Eur J Cardiothorac Surg 2009;36(3):465-468.

11.Sanz-Santos J, Andreo F, Castellà E, et al. Representativeness of nodal sampling with endobronchial ultrasonography in non-small-cell lung cancer staging. Ultrasound Med Biol 2012;38(1): 62-68.

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12.Nakajima T, Yasufuku K, Saegusa F, et al. Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for nodal staging in patients with lung cancer. Ann Thorac Surg 2013;95(5):1695-1699.

13.Jhun BW, Park HY, Jeon K, et al. Nodal stations and diagnostic performances of endobronchial ultrasound-guided transbronchial needle aspiration in patients with non-small cell lung cancer. J Korean Med Sci 2012;27(1):46-51.

14.Szlubowski A, Kuzdzał J, Kołodziej M, et al. Endobronchial ultrasound-guided needle aspiration in the non-small cell lung cancer staging.

Eur J Cardiothorac Surg 2009;35(2):332-335.

15.Bauwens O, Dusart M, Pierard P, et al. Endobronchial ultrasound and value of PET for prediction of pathological results of mediastinal hot spots in lung cancer patients. Lung Cancer 2008;61(3):356-361.

16.Joseph M, Jones T, Lutterbie Y, et al. Rapid on-site pathologic evaluation does not increase the efficacy of endobronchial ultrasonographic biopsy for mediastinal staging. Ann Thorac Surg 2013;96(2):403-410.

17.Lee BE, Kletsman E, Rutledge JR, et al. Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with nonsmall cell lung cancer. J Thorac Cardiovasc Surg 2012; 143(3):585-590.

18.Cerfolio RJ, Bryant AS, Eloubeidi MA, et al. The true false negative rates of esophageal and endobronchial ultrasound in the staging of mediastinal lymph nodes in patients with non-small cell lung cancer. Ann Thorac Surg 2010;90(2):427-434.

19.Navani N, Brown JM, Nankivell M, et al. Suitability of endobronchial ultrasound-guided transbronchial needle aspiration specimens for

subtyping and genotyping of non-small cell lung cancer: a multicenter study of 774 patients. Am J Respir Crit Care Med 2012;185(12):1316-

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20.Kuo C-H, Chen H-C, Chung F-T, et al. Diagnostic value of EBUS-TBNA for lung cancer with nonenlarged lymph nodes: a study in a tuberculosis-endemic country. PLoS ONE 2011;6(2):e16877.

21.Hu Y, Puri V, Crabtree TD, et al. Attaining proficiency with endobronchial ultrasound-guided transbronchial needle aspiration. J Thorac Cardiovasc Surg 2013;146(6):1387-1392.

22.Yasufuku K, Chiyo M, Koh E, et al. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung Cancer 2005;50(3):347-354.

23.Rintoul RC, Tournoy KG, El Daly H, et al. EBUS-TBNA for the clarification of PET positive intrathoracic lymph nodes-an international multi-centre experience. J Thorac Oncol 2009;4(1):44-48.

24.Cetinkaya E, Seyhan EC, Ozgul A, et al. Efficacy of convex probe endobronchial ultrasound (CPEBUS) assisted transbronchial needle aspiration for mediastinal staging in non-small cell lung cancer cases with mediastinal lymphadenopathy. Ann Thorac Cardiovasc Surg

2011;17(3):236-242.

25.Ernst A, Anantham D, Eberhardt R, et al. Diagnosis of mediastinal adenopathy—real-time endobronchial ultrasound guided needle aspiration versus mediastinoscopy. J Thorac Oncol 2008;3: 577-582.

26.Gu P, Zhao Y, Jiang L, et al. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a systematic review and meta-analysis. Eur J Cancer 2009;45(8):1389-1396.

27.Adams K, Shah PL, Edmonds L, et al. Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis. Thorax 2009;64:757-762.

28.Abu-Hijleh M, El-Sameed Y, Eldridge K, et al. Linear probe endobronchial ultrasound bronchoscopy with guided transbronchial needle aspiration (EBUS-TBNA) in the evaluation of mediastinal and hilar pathology: introducing the procedure to a teaching institution. Lung

2013;191(1):109-115.

29.Dong X, Qiu X, Liu Q, et al. Endobronchial ultrasound-guided transbronchial needle aspiration in the mediastinal staging of non-small cell lung cancer: a meta-analysis. Ann Thorac Surg 2013;96(4):1502-1507.

30.Whitson BA, Groth SS, Odell DD, et al. True negative predictive value of endobronchial ultrasound in lung cancer: are we being conservative enough? Ann Thorac Surg 2013;95(5):1689-1694.

31.Liberman M, Duranceau A, Grunenwald E, Martin J, Thiffault V, Khereba M, et al. New technique performed by using EUS access for biopsy of para-aortic (station 6) mediastinal lymph nodes without traversing the aorta. Gastrointest Endosc 2011;73(5):1048-1051.

32.Cerfolio RJ, Bryant AS, Eloubeidi MA. Accessing the aortopulmonary window (#5) and the para-aortic (#6) lymph nodes in patients with non-small cell lung cancer. Ann Thorac Surg 2007;84(3):940-945.

33.Szlubowski A, Zieliński M, Soja J, Annema JT, Sośnicki W, Jakubiak M, et al. A combined approach of endobronchial and endoscopic ultrasound-guided needle aspiration in the radiologically normal mediastinum in non-small-cell lung cancer staging-a prospective trial. Eur J Cardiothorac Surg 2010;37(5):1175-1179.

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34.Wallace MB, Pascual JM, Raimondo M, Woodward TA, McComb BL, Crook JE, et al. Minimally invasive endoscopic staging of suspected lung cancer. JAMA 2008;299(5):540-546.

35.Hwangbo B, Lee GK, Lee HS, Lim KY, Lee SH, Kim HY, et al. Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest 2010;138(4):795-802.

36.Block MI. Transition from mediastinoscopy to endoscopic ultrasound for lung cancer staging. Ann Thorac Surg 2010;89:885-890.

37.Annema JT, van Meerbeeck JP, Rintoul RC, Dooms C, Deschepper E, Dekkers OM, et al. Mediastinoscopy vs endosonography for

mediastinal nodal staging of lung cancer: a randomized trial. JAMA 2010;304(20):2245-2252.

38.Herth FJ, Krasnik M, Kahn N, Eberhardt R, Ernst A. Combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest 2010;138(4):790-794.

39.Zielinski M, Szlubowski A, Kołodziej M, Orzechowski S, Laczynska E, Pankowski J, 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):630-636.

40.Vilmann P, Krasnik M, Larsen SS, Jacobsen GK, Clementsen P. Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions. Endoscopy 2005;37(9):833-839.

41.Trisolini R, Cancellieri A, Tinelli C, et al. Rapid on-site evaluation of transbronchial aspirates in the diagnosis of hilar and mediastinal adenopathy: a randomized trial. Chest 2011;139:395-401.

42.Defranchi SA, Edell ES, Daniels CE, Prakash UB, Swanson KL, Utz JP, et al. Mediastinoscopy in patients with lung cancer and negative endobronchial ultrasound guided needle aspiration. Ann Thorac Surg 2010;90(6):1753-1757.

cervical mediastinoscopy. In these three series, 1 of 14 (7%) patients, 5 of 80 (6%) patients, and 2 of 39 (5%) patients, respectively, had significant bleeding requiring sternotomies. Airway obstruction due to hematoma was a life-threatening complication in one series. No patients in the three series died from undergoing mediastinoscopy. This complication is higher than reported in large series of patients without SVC syndrome

undergoing this procedure.1,2,3

Anatomic characteristics that would exclude patients from mediastinoscopy include aortic arch aneurysm and innominate artery calcification, which increase the risk for stroke, and existing tracheostomy. Patients who have limited neck mobility, including those with ankylosing spondylitis, also would not be candidates for cervical mediastinoscopy.

Patients who have received remote neck and chest radiation, as well as those who have had recent adjuvant chemoor radiotherapy, are candidates for mediastinoscopy. Mediastinoscopy can be repeated in patients who have received radiotherapy and in patients who present with a second malignancy. However, these patients may have inseparable adhesions that make performing repeat mediastinoscopy difficult. In addition, the lymph node sampling of a repeat mediastinoscopy is less sensitive than that of the primary mediastinoscopy.

Prior median sternotomy for cardiac surgery is not a contraindication to mediastinoscopy. Cardiac surgery typically does not violate the dissection plan used for mediastinoscopy, and mediastinoscopy outcomes in patients who have or have not had previous cardiac surgery are similar.

Nevertheless, surgeons should exercise good surgical judgment before offering mediastinoscopy and then intraoperatively in patients who have SVC syndrome or who have already undergone mediastinoscopy, have received neck radiation, or have undergone median sternotomy.

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3. PREPARING FOR COMPLICATIONS

Recommendation: Proper preparation of both the patient and the operating room team and the use of video mediastinoscopy are essential to effectively managing emergency complications during cervical mediastinoscopy.

Type of Data: Retrospective.

Strength of Recommendation: Weak.

Rationale

Although rare, complications during cervical mediastinoscopy have been described. To ensure the successful and safe completion of the procedure, the entire operative team must be prepared to manage any complications, and the patient should be properly positioned and draped. These precautions will result in better outcomes with less morbidity.

The patient should be supine, with a roll placed transversely beneath the shoulders. The neck should be extended maximally and the head supported. The trachea should be easily palpable. Once the patient is under general anesthesia, an arterial line or pulse oximeter is placed in the right upper extremity to detect prolonged compression of the innominate artery. The availability of blood for potential transfusion should be confirmed. The draping should include the neck and chest in the unlikely event of lifethreatening hemorrhage, airway injury, or pneumothorax requiring urgent intervention.

Plans for immediate emergent median sternotomy or thoracotomy in the event of hemorrhage or airway injury should be discussed during the preoperative time-out. All members of the nursing, circulating, and anesthesia teams must be aware of their roles in the event of an emergency situation.

To help ensure that all members of the operating room team are aware of what is happening surgically, video mediastinoscopy should be utilized so that all members of the surgery, anesthesia, and nursing teams can view the procedure simultaneously. However, video mediastinoscopy may not be feasible in all patients, as video mediastinoscopes, which are significantly larger than standard mediastinoscopes, may be too big to use in patients with limited space between the trachea and sternal notch and in patients with dense adhesions in this area. In these instances, a standard mediastinoscope must be used; therefore, both a video and standard mediastinoscope should be readily available. As only the surgeon is able to see the operative field with a standard mediastinoscope, proper communication is essential in the event of a complication.

Technical Aspects

Apart from issues of safety, studies have shown that video-assisted mediastinoscopy yields a higher number of lymph nodes than standard mediastinoscopy. However, owing to the larger size of the video instrument, video mediastinoscopy has been associated with slightly higher rates of recurrent nerve injury and pneumothorax. One recent report suggests that for patients with similar tumors, video mediastinoscopy not only yields a greater number of lymph nodes than standard mediastinoscopy but also far more frequently results in upstaging the disease. This results in fewer N2 false negatives undergoing surgery. The net effect is that patients who undergo video mediastinoscopy have better long-term survival than patients who undergo standard mediastinoscopy.

P.118 To successfully perform cervical mediastinoscopy, surgeons must know the anatomy of the innominate artery and vein, the aortic arch, the superior vena cava, the pulmonary artery, the azygous vein, the left recurrent nerve, the esophagus, and lymph node positions. Knowledge of this anatomy will result in an overall completion rate of 1%, including hemorrhage (0.3%), vocal cord dysfunction (0.5%), tracheal injury (0.01%), and

pneumothorax (0.09%).4 Other rare complications include incisional metastasis and chyle leak.

Prior to incision, the thyroid isthmus and either the innominate or carotid artery should be palpated to detect any vascular anomalies. Aberrant innominate artery and right common carotid artery originating from a common carotid trunk have been described. The incision (2 to 4 cm) should be made below the thyroid isthmus and above the sternal notch. The incision is carried down to the pretracheal fascia. Finger dissection between the anterior trachea and the pretracheal fascia is extended to the tracheal bifurcation and laterally along both sides of the trachea. Finger dissection should be used to lift the innominate artery off of the trachea, and the pretracheal plane should be opened digitally to access the paratracheal nodes. These nodes can often be palpated in both the left and right paratracheal spaces. The use of finger dissection may be responsible for the low incidence of recurrent nerve injury following mediastinoscopy. In a review of patients in whom vocal cord motion was monitored during mediastinoscopy, digital dissection of the anterior tracheal wall activated both recurrent nerves. Cautery in the left paratracheal plane activated the left recurrent nerve, but cautery in the subcarinal or right paratracheal space elicited little activity in the right recurrent nerve. The study’s findings suggest that recurrent

nerve injury is due to dissection and traction rather than cautery use.5

After the pretracheal plane has been opened, the mediastinoscope is inserted, and a suction dissector is used to open the subcarinal fascia.

After dissection has clearly revealed the lymph nodes in both the left and right paratracheal areas and in the subcarinal space, biopsy forceps can be used to sample these nodes. Several previous studies have reported that two to seven lymph nodes are sampled per procedure, but whether these studies were referencing individual

nodes or pieces of nodes is unknown.6,7,8,9 Interestingly, one study demonstrated that the volume of tissue sampled from a lymph node station was correlated with the presence of N2 disease. This study showed that

biopsy of a greater number of lymph node stations did not increase the chances of detecting N2 disease. The

author concluded that the larger volumes were taken from enlarged suspicious nodes.10

Catastrophic bleeding can be avoided by the use of aspiration, prior to biopsy, if there is any doubt as to the dissection of a lymph node. Lymph node stations 2R, 2L, 4R, 4L, and 7 should be subject to biopsy. The aortopulmonary window lymph nodes (stations 5 and 6) cannot be biopsied during standard mediastinoscopy.

Because mediastinoscopy is used to assess an area that has major vascular structures, hemostasis is necessary prior to closing the incision. The suction dissector can be used to control minor bleeding. In the event of major bleeding, the mediastinoscope should be left in place, and the area should be packed with gauze and hemostatic materials to control the bleeding. If these steps do not control the bleeding or if major vascular structures such as the pulmonary artery are injured, emergency median sternotomy or thoracotomy should be performed. In these cases, the preparatory measures discussed with the nursing and anesthesia teams prior to operation may be lifesaving. In Table 7-1, the reader will find a summary of significant publications on the utility, efficacy, and safety of cervical mediastinoscopy.

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TABLE 7-1 Summary of Mediastinoscopy References