Mediastinal Mass – Surgical Management in Apollo Hospitals Dhaka

Abstract

The aim of this study was to evaluate the role of surgical treatment for mediastinal tumors. A retrospective study was done from 6.8.2005 to 27.5.2014. Total 31 patients were included in this study. Age range was from 30 years to 70 years. Male was 18 and female was 13. Most of the tumour was thymoma (12 cases), thymoma with myasthenia gravis in 3 cases, Thymic carcinoma 2 cases, Nodular sclerosing Hodgkins lymphoma in 1 case, schawannoma in 2 cases, cystic mass in 5 cases, schawannoma with cystic degeneration in 1 case, fibromyxoma in 1 case, dermoid in 3 cases, teratoma in 2 cases, Fibrosing mediastinitis in thymic mass in 1 case, lymphoid hyperplasia in 1 case, malignant mesenchymal tumour in 1 case, myxoid liposarcoma in 1 case. Surgical exposure varies from strenotomy in 17 cases to clamshell incision in 1 case to postero-lateral thoracotomy in 12 cases and antero ateral thoracotomy in 1 case. Superior Venacava was injured in 1 case, repaired successfully by 6/0 prolene controlled by partial clamp. Some of the medistinal mass needed careful dissection from lung, pleura, encircling distal aortic arch and proximal part of left subclavian artery, encircling left brachiocephalic vein. 1 case needed Reconstruction of sternum with prolene mesh, marsupialization was done in 2 cases, adjacent pleura, fatty tissue, part of pericardium was removed in 5 cases. Lobectomy was needed in 1 case. In 1 case Recurrence of Fibrosing mediastinitis needed steroid therapy. Extensive growth of the tumour which involve surrounding vital structures was decided not to proceed for excision in 2 cases. Overall Five-years survival rate was 93.5%. 2 patients of the series died due to dieases process as they were advanced malignant medistinal mass. Surgical treatment done by cardiothoracic surgeon for mediastinal mass specially involving surrounding structures though challenging, gives good outcome