Robert Cameron1, Shahriyour Andaz2, Rick Peng1, Raja Mahidhara1.
1UCLA, Los Angeles, CA, USA, 2Long Island Thoracic Surgery, PC, Lynbrook, NY, USA.
OBJECTIVE: The utility of performing a cervical approach to the AP window (cervical mediastinotomy) has been underutilized and hard to teach. We evaluated our experience in over 100 patients regarding indications, cervical access, and outcomes. In addition, we analyzed anatomic variations in order to predict the ease of performing the procedure.
METHODS: We reviewed out experience with cervical mediastinotomy, our ability to perform the procedure, outcomes and results in patients seen in our practice over the last 10 years. We analyzed CT scan data when available regarding various anatomic considerations in order to predict ease of completing the operation.
RESULTS: We identified 100 patients who underwent cervical mediastinotomy either alone or in conjunction with cervical mediastinoscopy. The majority of the patients were being staged for lung cancer (left upper lobe). There were no complications over and above that of standard mediastinoscopy. We found that the product of the thoracic inlet distance (TI; measured between the manubrium and the spine) and the anterior mediastinum (AM; measured between the aortic arch and sternum) was predictive of successful completion of the procedure. A cervical mediastinotomy index (CMI) of >20 indicated a procedure that generally can be completed easily while an index of <7.0 indicated a procedure that required an experienced surgreon if it could be completed at all. An index between 7 and 10 undicated an intermediate difficult that was routinely done by expereinced surgeons but not as easily completed by less experienced surgeons.
CONCLUSIONS: Cervical mediastinotomy is a safe, accureate, but underutilized procedure. The difficult can be predicted by the CMI and this can be used to select cases early in a surgeons experience so that successful completion is most likely.
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