Objective: The aim of this study was to assess the usefulness of combined video-assisted mediastinoscopy
(VM) and video-assisted thoracoscopy (VT) in the management of patients with lung
cancer.
Methods: A prospective observational study was performed over a 5-year period. Indications for
combined VM and VT included inconclusive findings from imaging techniques concerning locoregional
extension and resectability; possible involvement of different structures not accessible to a
single procedure; and failure to obtain a histologic diagnosis with a single technique.
Results: An indication for combined exploration was established in 30 patients, representing 2.6%
of all the patients referred to us for diagnosis, staging, and/or resection of lung cancer. Combined
VM and VT was completed in 28 patients, as pleural carcinosis was found at VT in 2 cases. There
was no mortality or morbidity in our series. Histologic diagnosis was obtained in 12/13 patients without
preoperative histologic typing. In all the evaluated patients, combined VM and VT was useful
in clinical decision-making, leading to immediate surgery (n = 10), induction treatments (n = 8), or
nonsurgical therapy (n = 12). Among the patients who underwent immediate surgery, combined
VM and VT never failed to assess the T factor. The N factor was correctly evaluated in 8/10 patients,
and in 2 patients it failed to recognize a minimal N2 disease.
Conclusion: Combined VM and VT is a safe and useful tool in the management of selected patients
with lung neoplasms. Both the extent of primary tumor and the possible intrathoracic spread
can be thoroughly evaluated.
