https://doi.org/10.55788/5e8370b2
“The guidelines tell us to perform endosonography and confirmatory mediastinoscopy in advance of anatomical resection and lymph node dissection in patients with resectable NSCLC,” said Prof. Jouke Annema (Amsterdam UMC, the Netherlands) [1,2]. However, the role of confirmatory mediastinoscopy is under debate due to the upcoming experience and accuracy of endosonography as well as the negative impact that this surgical procedure may have on patients. Dr Annema and colleagues conducted the non-inferiority MEDIASTrial to assess whether confirmatory mediastinoscopy could be omitted after tumour-negative, systematic endosonography [2].
In total, 346 patients with resectable NSCLC were randomised 1:1 to immediate lung tumour resection or to mediastinoscopy. Unforeseen N2 disease after lymph node dissection was the primary outcome, with a non-inferiority margin of 8%.
In the intention-to-treat analysis, unforeseen N2 disease was observed in 8.8% of the participants in the immediate intervention group compared with 7.7% in the mediastinoscopy group (non-inferiority P=0.014). Likewise, in the per-protocol analysis, unforeseen N2 disease was identified in 9.0% of the participants in the immediate resection arm and in 8.2% of the participants in the mediastinoscopy arm (non-inferiority P=0.016). Major morbidity rates were comparable between the 2 groups, with 12% and 13% in the immediate resection and mediastinoscopy arm respectively. Finally, 30-day mortality data displayed that 2 deaths had occurred in the immediate resection arm and that 5 deaths had occurred in the mediastinoscopy arm (P=0.27).
The MEDIASTrial demonstrated that confirmatory mediastinoscopy could be omitted after negative systematic endosonograpy in patients with resectable NSCLC, concluded Prof. Annema.
- Vilmann P, et al. Endoscopy. 2015;47(6):545–559.
- Annema JT, et al. Endosonography with or without confirmatory mediastinoscopy for resectable lung cancer: A randomized clinical trial. ALERT 4, RCT4452, ERS International Congress 2022, Barcelona, Spain, 4–6 September.
Copyright ©2022 Medicom Medical Publishers
Posted on
Previous Article
« Antibiotics cause increased risk of wheezing in severe RSV bronchiolitis Next Article
Cone beam CT-guided ENB improves detection of pulmonary nodules »
« Antibiotics cause increased risk of wheezing in severe RSV bronchiolitis Next Article
Cone beam CT-guided ENB improves detection of pulmonary nodules »
Table of Contents: ERS 2022
Featured articles
Letter from the Editor
COVID-19: What Is New?
Does vilobelimab reduce mortality in severe COVID-19?
Awake proning not positive in COVID-19
Favipiravir may help patients over 60 years with COVID-19 to recover
Inhaled agent under investigation for COVID-19
Accurate voice-based COVID-19 diagnostic test in development
Novel scoring tool for post-COVID syndrome aids clinicians and researchers
COPD: Therapies and Innovations
Icenticaftor achieves results on top of triple inhalation therapy in COPD
STARR2: A new approach for treating COPD exacerbations
COPD medication not effective in symptomatic smokers with preserved spirometry
Do digital tools improve physical activity in COPD?
Hyperpolarised gas MRI ready for clinical use
All About Asthma
Tezepelumab in asthma: mucus plugging down, lung function up
Digital asthma intervention improves health and reduces costs
Digitally enhanced therapy lowers treatment burden and costs in severe asthma
Mepolizumab beneficial for patients with severe eosinophilic asthma
Progress in Paediatrics
Antibiotics cause increased risk of wheezing in severe RSV bronchiolitis
Inhaled corticosteroids useful in preterms with decreased lung function
Fish oil or vitamin D during pregnancy can prevent croup
Encouraging results of nintedanib in children with fibrosing ILD
Focus on Interventional Pulmonology
Head-to-head: lung volume reduction surgery vs endobronchial valves
Durable effect of endobronchial valves in severe emphysema
Cone beam CT-guided ENB improves detection of pulmonary nodules
Confirmatory mediastinoscopy not needed in resectable NSCLC
Sleep and Breathing Disorders
In the spotlight: Cancer trends in obstructive sleep apnoea
Impact of CPAP on cardiac endpoints in OSA
Sustained hypoxaemia predicts unprovoked VTE in OSA
CPAP therapy in the prevention of cardiovascular risk in patients with OSA
Other Remarkable Research
Excellent results for high-flow nasal cannula oxygen therapy in acute respiratory failure
Antifibrotic therapy may slow down FVC decline in RAILD
Intravenous N-acetylcysteine performs well in hospitalised patients
Men and women respond differently to diesel exhaust
New trends in cystic lung diseases
Related Articles
August 17, 2022
Fatigue syndrome in sarcoidosis
![](https://conferences.medicom-publishers.com/wp-content/uploads/2022/05/Table-Patient-reported-outcomes-in-POSEIDON-1024x671.png)
© 2024 Medicom Medical Publishers. All rights reserved. Terms and Conditions | Privacy Policy
HEAD OFFICE
Laarderhoogtweg 25
1101 EB Amsterdam
The Netherlands
T: +31 85 4012 560
E: publishers@medicom-publishers.com