Mediastinal Lymph Node Dissection

What is Mediastinal Lymph Node Dissection?

This surgical procedure involves removing lymph nodes between the lungs (mediastinum) to:
Stage lung cancer accurately
Determine cancer spread
Guide treatment planning

It’s typically performed during lung cancer surgery or as a standalone diagnostic procedure.

When is it Necessary?

Common indications include:

• Non-small cell lung cancer (NSCLC) evaluation
• Suspected lymph node metastasis
• Esophageal cancer staging
• Diagnosis of lymphomas or sarcoidosis

Surgical Approaches

1. Mediastinoscopy

• Small neck incision
• Camera-guided node sampling
• Outpatient procedure in most cases

2. VATS (Video-Assisted Thoracoscopic Surgery)

• Minimally invasive chest approach
• Allows more extensive dissection

3. EBUS-TBNA (Endobronchial Ultrasound)

• Needle biopsy through bronchoscope
• Least invasive option

4. Open Thoracotomy

• For complex cases
• Provides full nodal access

The Procedure Step-by-Step

1. General anesthesia administration
2. Incision (location depends on approach)
3. Identification and removal of target nodes
4. Pathology evaluation (frozen section possible)
5. Closure with minimal drainage needed

Recovery Expectations

Why Accurate Staging Matters

• Changes treatment strategy in 25-30% of cases
• Determines surgery eligibility
• Impacts prognosis predictions
• Guides chemotherapy/radiation plans

Potential Risks

• Recurrent laryngeal nerve injury (voice changes)
• Bleeding (rare but serious)
• Chylothorax (lymph fluid leakage)
• Infection (minimized with antibiotics)

Advances in Technique

• Robotic-assisted dissections improving precision
• Molecular testing of nodes guiding targeted therapy
• Sentinel node mapping reducing extent of dissection

Conclusion

This procedure remains essential for accurate cancer staging, with minimally invasive techniques reducing recovery times.