Surgical management of mediastinal teratoma: report of 113 cases

Abstract

Objective To summarize our experience in patients with mediastinal teratoma managed by surgical intervention. Methods From January 1980 to December 2013, 113 patients(48 males and 65 females) were diagnosed with mediastinal teratoma and underwent surgical treatment at our hospital. Median age was(32.6±7.3) years. Seventy-seven patients underwent operation for a variety of symptoms, and 36 patients for the abnormal roentgenograms. The locations of mediastinal teratoma were 57 cases in the left anterior mediastinum, 45 cases in the right anterior mediastinum, 9 cases in the chest and 2 cases extension from mediastinum to neck. Thoracic computerized tomography was performed in 95 patients. CT features of cystic teratoma were cystic mass with fluid density. CT features of solid teratoma were soft-tissue mass with mixed densities.The other CT features included ascus in cyst, fat density, and calcification. Preoperative diagnosis for the mediastinal teratoma was made in 58 cases(51.3%). The operation was via posterior lateral thoractomy in 55 cases, video-assisted thoracoscopic surgery(VATS) in 13 cases, median sternotomy in 22 cases, median sternotomy with anterior lateral thoractomy in 6 cases, anterior lateral thoractomy in 15 cases, and cervical incision with median sternotomy in 2 case. The operation was simple resection of tumor in 67 cases, teratoma resection with pulmonary resection in 41 cases, teratoma resection with partial resection of innominate vein in 1 case, debulking resection in 2 case and biospy in 2 cases for the immature teratoma. Results There was one postoperative death, and the operative complication occurred in 9 patients(8.0%). The average operation time was(167.5±46.8) min, and the average blood loss was(271±105) ml. The postoperative hospital stay was(8.6±3.5) days on average. Follow-up was completed in 96 patients(85.0%) ranged from 12 to 108 months(average, 65.4 months). Six patients with immature teratoma were deceased from distant metastases and there was no recurrence or death in the other patients at the time of follow-up. Conclusion Surgical resection is an effective method of management for mediastinal teratoma. The surgical incision should be chosen by the size and location of the tumor. Key words: Mediastinal neoplasms; Teratoma; Diagnosis; Thoracic surgical procedures