Abstract
Describing the changes in surgical procedures and factors affecting the surgical outcome of patients who have undergone complete resection of giant mediastinal tumors (GMTs, diameter ≥ 10 centimeters) could improve preoperative decision-making and prognostic evaluations. We accessed data from three sources, which are case reports on surgical treatment of GMTs from PubMed, Web of Science, and EMBASE until June 1, 2019; patients with resected GMT from the Surveillance, Epidemiology, and End Results (SEER) database; and retrospective review of medical records in our institution from 2000 to 2019. The worldwide distribution, clinicopathological characteristics, symptom profile, prognosis of patients with GMT resection, and nomogram for surgical outcome prediction are reported. A total of 242 rare GMT cases from four continents (Asia, North America, South America, and Europe) were included. The median age of the patients was 40 (IQR: 27, range: 13–83) years, and the male-to-female ratio was 1.57:1. Dyspnea, shortness of breath, cough, and chest pain or discomfort were the major symptoms at presentation. The prognosis of benign and low-grade malignant GMTs was superior to that of high-grade malignant GMTs. Tumor malignancy played the most critical role in predicting postoperative survival, followed by longest tumor diameter and a posterior mediastinum location. The findings of this study suggest that the number of successful GMT surgeries has increased over the last decade and describe clinical features of GMTs. Physicians should prioritize tumor malignancy as a leading factor in predicting outcome rather than tumor size.
Highlights
Giant mediastinal tumors (GMTs) with a diameter greater than or equal to 10 centimeters rarely occur but often impose challenges in the surgical and anesthesia community [1, 2]
Consistent with pathological trends, we provided evidence that benign GMTs had an improved recurrence-free survival compared with malignant GMTs (Figure 3A) and low-grade GMTs (Figure 3B) (P < 0.001)
We found that tumor malignancy played the most critical role in predicting postoperative survival, followed by tumor longest diameter and posterior mediastinum location
Summary
Giant mediastinal tumors (GMTs) with a diameter greater than or equal to 10 centimeters rarely occur but often impose challenges in the surgical and anesthesia community [1, 2]. The clinical presentation and pathological diagnosis vary from case to case [3, 4] Despite these tumors having variable malignant potential, complete resection is considered the first-line treatment in appropriate cases. A large tumor size is a poor prognostic factor in cancer medicine, patients with GMTs tend to have low-grade tumors, and tumor size does not seem to be the most critical prognostic factor. We hypothesized that this entity would have different survival risk factors from smaller tumors due to its slow growing nature
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