What Is a Mediastinal Lymphadenectomy?

How does mediastinal lymphadenectomy help with cancer staging?

Because of its excellent diagnostic accuracy, mediastinal lymphadenectomy is a critical technique for TNM (tumor, node, and metastasis) cancer staging.

The lymph system is a network of vessels and nodes that help the body fight illness. When an infection occurs, lymph nodes in the affected area can swell and become uncomfortable. An enlarged lymph node can occasionally be a sign of cancer. You may feel a lump, typically in the armpit, groin, or neck area, but lymph nodes can be found in places you cannot feel such as the gap between your lungs. Swollen nodes are often discovered during a CT scan.

In order to determine the cause of swollen lymph nodes, your doctor may recommend a biopsy. There are two methods for evaluating lymph nodes, one of with is a mediastinal lymphadenectomy:

• Systematic mediastinal lymph node sampling (MLNS): Resection of nodes from each ipsilateral mediastinal station may be required.
• Mediastinal lymph node dissection (MLND), also called mediastinal lymphadenectomy: Removal of all mediastinal nodes and soft tissue within anatomical markers.

What are the advantages and limitations of mediastinal lymphadenectomy?

Advantages

• Ability to provide accurate staging
• Removes undetected micro metastasis
• Delays recurrence and complete resection of the lesion
• Allows for better patient selection in relation to adjuvant therapy

Disadvantages

• Carries higher risks of morbidity and requires a longer operative time, without any obvious survival benefit

What is mediastinal lymphadenopathy?

Mediastinal lymphadenopathy occurs when the lymph nodes in the mediastinum swell and become enlarged as a result of a specific disorder on its own or in conjunction with other lung conditions. It is usually less than 10 mm in diameter.

In general, mediastinal lymphadenopathy indicates a lung problem. It is generally associated with tuberculosis and, less commonly, with lung cancer and chronic obstructive pulmonary disease. 

Cancer cells from the lungs often find their way into mediastinal lymph nodes, which indicates that the cancer is spreading. Mediastinal lymphadenopathy is linked to lymphomas, which are a type of cancer that starts in the white blood cells called lymphocytes (part of your immune system that fights germs). Hodgkin’s lymphoma (HL) and non-Hodgkin lymphoma (NHL) are two types of lymphomas. Over 85% of people with HL have mediastinal lymphadenopathy, whereas only 45% of people with NHL have it.

Antibiotics are used as first line treatment for mediastinal lymphadenopathy. A biopsy may be considered if cancer is suspected due to symptoms such as frequent fevers or weight loss.

How is a mediastinal lymphadenectomy performed?

Mediastinal lymphadenectomy is performed under general anesthesia.

• Your doctor may make a small incision in the hollow area at the base of your throat.
• A lighted scope is inserted into the mediastinal area behind your sternum.
• Mediastinal nodes and soft tissue within anatomical landmarks are removed and sent to the pathology department.
• The scope is removed, and the incision is closed with under-the-skin absorbable sutures.
• Although the actual number of lymph nodes recovered from individual nodal sites vary greatly, full mediastinal lymphadenectomy removes one or more lymph nodes from all mediastinal stations.

What is the follow-up after a mediastinal lymphadenectomy?

After the procedure, you may be asked to return for follow-up after one week to discuss the results

Most swollen lymph nodes are the result of a past infection. In rare cases, however, a lymph node may be discovered to be cancerous. Some types of lymph node cancer are tumors that began elsewhere and progressed to the lymph nodes, whereas other types are cancer of the lymph nodes themselves. In either situation, you will be directed to an oncologist to discuss treatment.