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Publicatie in The Annals of thoracic surgery

Eind 2018 verscheen een publicatie met data uit de Dutch Lung Cancer Audit - Surgery (DLCA-S) in The Annals of thoracic surgery.

Mediastinoscopy for staging of Non-Small Cell Lung Cancer: surgical performance in the Netherlands. 

Auteurs: Hoeijmakers, F., Heineman, D. J., Beck, N., Klamer, J., Tollenaar, R. A., Wouters, M. W., & Schreurs, W. H.

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To determine optimal treatment options in non-small cell lung cancer (NSCLC), accurate staging of the mediastinal lymph nodes is of great importance. In case of suspected mediastinal metastases, EUS/EBUS combined with mediastinoscopy is the gold standard. Diagnostic value of these procedures stands or falls by how they are technically performed. The aim of this study is evaluating surgical performance of mediastinoscopies in the Netherlands, using data from the Dutch Lung Cancer Audit for Surgery.


From 2012-2016, all patients with a mediastinoscopy for staging of NSCLC and subsequent resection were included. Complete case analysis was performed, excluding patients with missing data on biopsies and/or tumor side. Location and number of biopsied stations and adherence to guidelines for performing mediastinoscopy were analyzed. Subsequently, the proportion of unforeseen mediastinal lymph node metastases (unforeseen N2) was compared between mediastinoscopies that did or did not comply to the Dutch guideline.


1729 patients were included for analysis. Respectively 51.4% (n= 888) and 75.4% (n=1303) of the mediastinoscopies were performed according to the Dutch guideline (requirements: biopsies of 2 ipsilateral stations, 1 contralateral station and N7) and to the ESTS guideline (N4 left, N4 right and N7). Overall, unforeseen N2 was present in 10.2% (n=140). In mediastinoscopies performed according to the Dutch guideline unforeseen N2 occurred less often (8.6%) than in the non-adherence group (11.9%; p=0.043).


There is improvement potential in surgical performance of mediastinoscopy in the Netherlands, which is reflected by the percentage of guideline adherence and the occurrence of unforeseen N2.