Optimal mediastinal staging in non-small cell lung cancer: what is the role of TEMLA and VAMLA?

Abstract

Objectives: The aim of this review is to present the current role of two techniques of extensive mediastinal dissection, in the staging of lung cancer.

Materials and methods: The authors performed a search for original papers published in English language, peer-reviewed journals.

Results: According to the published evidence, definitions of VAMLA and TEMLA are given and the main elements of the operative technique are briefly presented. Extensiveness and completeness of mediastinal lymph node dissection using these techniques, their diagnostic yield as well as complications and use of hospital resources are discussed. The role of VAMLA and TEMLA in the contemporary staging of lung cancer is presented in context of other staging techniques and the current clinical practice guidelines.

Conclusion: On the basis of the evidence currently available, it may be concluded that VAMLA and TEMLA have no contemporarily use in the routine mediastinal staging of lung cancer. This is because of their invasiveness and - at least for TEMLA - high risk of complications and mortality, which renders it unacceptable as a diagnostic procedure, and also due to the development of equally accurate, but far less invasive techniques, i.e. EBUS-NA and EUS-NA.

Keywords: Lung cancer; Mediastinum; Staging.