An alternative approach for addressing mediastinal tumours through mini-invasive surgery (original) (raw)
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Surgery for invasive primary mediastinal tumors
The Annals of Thoracic Surgery, 1998
Background. There have been few reports on results after extended radical resection for primary mediastinal tumors invading neighboring organs. Methods. A retrospective analysis of 89 patients who underwent total or subtotal resection of a primary mediastinal tumor with resection of at least part of an adjacent structure between 1979 and 1995 was performed. Clinical data were collected from the medical records. Results. There were 35 invasive thymomas, 12 thymic carcinomas, 17 germ cell tumors, 16 lymphomas, 3 neurogenic tumors, 3 thyroid carcinomas, 2 radiationinduced sarcomas, and 1 mediastinal mesothelioma. The tumor was located in the anterior mediastinum in 74% of patients. Residual masses after chemotherapy were excised in 14 patients with germ cell tumor and 8 with lymphoma. A median sternotomy was the most frequently used approach (79% of patients). Total resection was achieved in 79% and significantly improved survival (p < 0.01). Adjacent resected structures included 38 phrenic nerves, 21 superior venae cavae, 16 upper lobes, and 13 innominate veins, in 5 patients, a pneumonectomy was required. The complication rate was 17% and the mortality rate, 6%. With follow-up available for 86 patients, the overall 5-year survival rate was 69% for patients with thymoma, 42% for patients with thymic carcinoma, 48% for patients with germ cell tumor, and 83% for patients with lymphoma. Conclusions. Malignant mediastinal tumors can be safely resected even if they have invaded other mediastinal structures. Complete resection is important to achieve satisfactory long-term survival. A median sternotomy is an excellent approach, and a preoperative diagnosis by biopsy is desirable. Residual masses after chemotherapy for lymphoma or germ cell tumor should be resected. Extensive resection without a preoperative diagnosis is not indicated.
Mediastinum
Background: There is no standard surgical approach to deal with anterior mediastinal disorders specially tumors with a diameter larger than 4 cm. Radical resection and speciment retrieval in minimally invasive surgery can be challenging. Methods: We describe the first 4 cases of our initial experience dealing with large anterior mediastinal masses in a minimally invasive way. We combined the left side video-assisted thoracic surgery (VATS) approach with a single subxiphoid incision to achieve radical resection and remove the specimen at the end of the procedure without rib spreading. Results: The operative time ranged from 117 to 151 minutes. Blood loss was less than 150 mL during the procedures. Patients were discharged at the third post-operative day with minimal discomfort at the subxiphoid region. No morbidity/mortality was observed. Conclusions: Such procedure offers a safe option to deal with lesions without apparent invasion of other organs (mainly thymic tumors), allowing a good exposure for safe radical resection and for preserving both phrenic nerves. In the future we will consider this combined approach for lesions with a diameter of more than 4 cm and no radiological signs of infiltration.
Superior mediastinal tumour excision through upper partial sternotomy and chamberlain incision
International Surgery Journal, 2021
Superior mediastinal mass excision can be performed by various approaches such as partial sternotomy, mini trapdoor incision, anterior cervical transsternal approach and lateral thoracotomies. However, adequate exposure especially of superior surface seems to be difficult. Total four patients of superior mediastinal mass were admitted in the department of cardiothoracic and vascular surgery, Safdarjung hospital, New Delhi between June 2019 to May 2021. All of them were operated by upper partial sternotomy with right or left chamberlain extension of incision. It is safe and effective in terms of exposure with early recovery as well as cosmesis. Hence, we advocate the use of upper partial sternotomy with left or right chamberlain incision which provides good exposure in addition to ease of patient position, vascular control and emergency institution of cardiopulmonary bypass.
Recent advances in video-assisted thoracoscopic approach to posterior mediastinal tumours
The Surgeon, 2010
a b s t r a c t Minimal invasive video-assisted thoracic surgery can be a safe alternative technique in the assessment, diagnosis and surgical resection of posterior mediastinal tumours. Videoassisted thoracic surgery may be particularly suited for the management of posterior mediastinal tumours as most are benign. Surgical technique continues to evolve from the classic 3-port access in order to tackle more complex tumours positioned at the apical and inferior recesses of the posterior mediastinum. The preoperative identification of dumbbell tumours is important to facilitate arrangements for a single-stage combined resection for both the intra-thoracic and intraspinal tumour. Results from Video-assisted thoracic surgery posterior mediastinal tumour resection are comparable with conventional surgical techniques in terms of symptomatic improvement, recurrence and survival. Video-assisted thoracic surgery approach has been shown to result in less post-operative pain, improved cosmesis, shorter hospital stay, and more rapid recovery and return to normal activities. In over a decade, video-assisted thoracic surgery has gradually matured and is now a promising therapeutic alternative to open approach. In certain selected patients, video-assisted thoracic surgery may be considered the standard of care for conditions of the posterior mediastinum. Recent developments in robotic surgery for the management of mediastinal tumours are promising, however, long-term results are pending.