Video-Assisted Mediastinoscopic Lymphadenectomy for Staging Non-Small Cell Lung Cancer  Sergi Call, MD, Carme Obiols, MD, PhD, Ramon Rami-Porta, MD, PhD,

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Video-Assisted Mediastinoscopic Lymphadenectomy for Staging Non-Small Cell Lung Cancer  Sergi Call, MD, Carme Obiols, MD, PhD, Ramon Rami-Porta, MD, PhD, Juan Carlos Trujillo-Reyes, MD, Manuela Iglesias, MD, Roser Saumench, MD, Guadalupe Gonzalez-Pont, MD, PhD, Mireia Serra-Mitjans, MD, Jose Belda-Sanchís, MD, PhD  The Annals of Thoracic Surgery  Volume 101, Issue 4, Pages 1326-1333 (April 2016) DOI: 10.1016/j.athoracsur.2015.10.073 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Flow chart of patient selection (NSCLC = non-small cell lung cancer; SCLC= small cell lung cancer; VAMLA = video-assisted mediastinoscopic lymphadenectomy.) The Annals of Thoracic Surgery 2016 101, 1326-1333DOI: (10.1016/j.athoracsur.2015.10.073) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Endoscopic images of video-assisted mediastinoscopic lymphadenectomy (VAMLA). (A) View of subcarinal space after removing all subcarinal lymph nodes. (B) View of right mediastinal pleura after removing right inferior paratracheal lymph nodes. (C) View of left recurrent laryngeal nerve (yellow arrowheads). It is important to identify this anatomical structure before starting dissection and resection of lymph nodes in inferior left paratracheal lymph node compartment. (E = esophagus; LB = left main bronchus; MP = right mediastinal pleura; PA = pulmonary artery; RB = right main bronchus; SVC = superior vena cava; T = trachea.) The Annals of Thoracic Surgery 2016 101, 1326-1333DOI: (10.1016/j.athoracsur.2015.10.073) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Sixty-year-old female patient with a nodule in the right hilum detected on chest roentgenogram requested for respiratory infection. Computed tomography (CT) of chest showed 32-mm nodule in the middle lobe. Bronchoscopic biopsy results were diagnostic of adenocarcinoma. Positron emission tomography–computed tomography (PET-CT) showed abnormal uptake in nodule. With clinical diagnosis of cT2aN0M0 adenocarcinoma in the right hilum, video-assisted mediastinoscopic lymphadenectomy (VAMLA) was indicated. (B) Scheme of all removed lymph nodes (n = 24) from right and left inferior paratracheal nodal stations, subcarinal station, and superior paraesophageal lymph node station. One lymph node in right inferior paratracheal station was positive for malignancy. The Annals of Thoracic Surgery 2016 101, 1326-1333DOI: (10.1016/j.athoracsur.2015.10.073) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Rate of unsuspected N2 disease depending on presurgical cTNM staging. (MT = multimodality treatment; Synchr. = synchronous; uN2 = unsuspected N2 disease.) The Annals of Thoracic Surgery 2016 101, 1326-1333DOI: (10.1016/j.athoracsur.2015.10.073) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions