To the Editor.—Dr. Sabiston pointed out (Arch Surg 109:118, 1974) that mediastinoscopy in patients with carcinoma of the lung is controversial. He further pointed out that some surgeons hold that patients with mediastinal metastases are notcandidates for thoracotomy. I think it is important to clarify this to the extent that patients who have oat cell carcinoma with mediastinal metastasis are probably not candidates at all. Patients who have epidermoid carcinoma or adenocarcinoma with ipsilateral metastasis may be resectable and should at least undergo exploratory surgery. However, patients who have contralateral metastasis are probably not operable (curable). This leaves another can of worms to contemplate. Should patients who have only ipsilateral mediastinal metastasis then be subjected to scalene node biopsy? Clearly, a patient in that situation with a positive scalene node biopsy would be inoperable.
As Dr. Sabiston has stated, this is a very controversial subject, but much of this