• Michèle De Waele, Jeroen Hendriks, Patrick Lauwers, Paul Ortmanns, Wim Vanroelen, Ann-Marie Morel, Paul Germonpré, and Paul Van Schil.
• Department of Thoracic and Vascular surgery, University Hospital of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
• Eur J Cardiothorac Surg. 2006 Feb 1; 29 (2): 240-3.

ObjectiveRemediastinoscopy is a valuable tool in restaging non-small cell lung cancer after induction therapy for mediastinal nodal involvement as it provides pathological evidence of response and may select patients for subsequent thoracotomy. However, long-term survival data after remediastinoscopy are scarce.MethodsFrom November 1994 to April 2003, a remediastinoscopy was performed in 32 patients (29 men, 3 women) after induction therapy for locally advanced non-small cell lung cancer. Mean age was 67.8 years (range, 47-83). Neoadjuvant chemotherapy was given in 26 patients and chemoradiotherapy in 6. Follow-up data were completed in January 2005.ResultsRemediastinoscopy was technically feasible in all patients. There were five false-negative remediastinoscopies, resulting in a sensitivity of 71%, specificity of 100% and accuracy of 84%. Follow-up was complete in all patients. Median survival time for the whole group was 21 months (95% confidence interval [CI] 9-33). Median survival time in patients with a positive remediastinoscopy was 7 months (95% CI 5-9), with a negative remediastinoscopy 41 months (95% CI 13-69), and with a false-negative remediastinoscopy 24 months (95% CI 5-43). The difference between positive and negative remediastinoscopies was highly significant (p=0.003). In the combined group of patients with positive and false-negative remediastinoscopies (n=17), median survival time was 8 months (95% CI 3-13). The difference with negative remediastinoscopy remained significant (p=0.012). In a multivariate analysis, including sex, age, histology and nodal status at repeat mediastinoscopy, only nodal status was a significant independent prognostic factor (p=0.015).ConclusionsRemediastinoscopy is a valuable restaging procedure after induction therapy. Prognosis is poor in patients with persisting mediastinal nodal involvement, proven at repeat mediastinoscopy.

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