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Five years experience with treatment of lung cancer. The role of mediastinoscopy.

Over a five-year period, 304 patients with non small cell carcinoma of the lung were evaluated for pulmonary resection. The patients were divided into three groups: 1) 180 patients operated without preoperative mediastinoscopy based on a normal appearing mediastinum on plain chest x-ray; 2) 107 patients with resection of both lung tissue and mediastinal tissue due to localised positive mediastinoscopic findings; 3) 17 patients who were found inoperable either due to poor lung function or diffuse mediastinal seeding. In group 1, 24% were peroperatively found to be inoperable due to mediastinal involvement. The rest were resected and received no further therapy. In group 2, 84 patients were resected and postoperatively irradiated on the mediastinal area. The incidence of bronchopleural fistulae in group 1 was 0.7% and in group 2 16%, and the survival at any period was significantly poorer for group 2 than for group 1. We conclude that every patient with pulmonary infiltrates must be subjected to mediastinoscopy before thoracotomy and should be excluded from operative intervention in the presence of positive mediastinoscopic findings.