Resection Of Anterior Mediastinal Mass Research Articles

Quality of life after anterior mediastinal mass resection: a prospective study comparing open with robotic-assisted thoracoscopic resection☆

To prospectively evaluate quality of life (QoL) evolution after robotic-assisted thoracoscopic or open anterior mediastinal tumour resection with the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire-C30 and the lung cancer-specific module, LC-13. From January 2004 to December 2008, QoL was prospectively recorded in all patients undergoing surgery for mediastinal tumours. A total of 14 patients underwent thoracoscopic resection using the da Vinci robotic system (Intuitive Surgical, Inc., Mountain View, CA, USA), and 22 patients open resection through sternotomy. Questionnaires were administered before surgery and 1, 3, 6 and 12 months, postoperatively, with response rates of 100%, 86.1%, 94.4%; 75.0% and 86.1%, respectively. Both approaches had comparable preoperative patients' characteristics and QoL subscales. Open resection by sternotomy was characterised by a significant decrease in general functioning 1 month after surgery (physical functioning p=0.001, role functioning p=0.001, and social functioning p=0.044). Patients also complained of increased thoracic pain in the first 3 months after surgery (p=0.017). After a da Vinci robotic resection QoL scores approximated baseline preoperative values 1 month after surgery, with the exception of increase in thoracic and shoulder pain the first 3 months after surgery (p=0.028 and 0.029, respectively). Numerous techniques have been published with different degrees of invasiveness, generating the existing controversy as to which is the best surgical approach for anterior mediastinal tumours. The high burden of decreased physical functioning reported after sternotomy is not seen after a da Vinci robotic-assisted thoracoscopic resection. The initial experience and postoperative QoL data are excellent and, therefore, the da Vinci robot will stay our future technique of choice for the treatment of resectable mediastinal tumours smaller than 4 cm on imaging techniques.

Thorascopic Mediastinal Resection After Median Sternotomy and Mediastinotomy

Previous mediastinal surgery may be considered a contraindication to minimally invasive resection of anterior mediastinal masses. We have found video-assisted thoracoscopic resection of anterior mediastinal masses to be technically feasible after sternotomy or chamberlain procedures. Changes in positioning and port location may facilitate these procedures.

One-stage approach for retroperitoneal and mediastinal metastatic testicular tumor resection

Background. Eight percent of nonseminomatous germ cell tumors of the testis are associated with postchemotherapy residual masses in both the retroperitoneum and the posterior mediastinum. We describe a transabdominal transdiaphragmatic approach that allows simultaneous resection of these masses. Methods. After standard retroperitoneal lymph node dissection through a midline laparotomy, an incision parallel to the right crus of the diaphragm was made and extended anteriorly through the muscular portion. Excellent exposure of the lower posterior mediastinum was obtained. Masses located higher than vertebra T8 were resected by extending this incision anteriorly and performing a partial sternal division. A complete median sternotomy can be done to allow subcarinal dissection, as well as pulmonary or anterior mediastinal mass resection. Results. Between 1993 and 1999, 18 patients had simultaneous resection of retroperitoneal and posterior mediastinal masses with this approach. There were no perioperative deaths; 3 patients had minor postoperative complications. After a median follow-up of 3.2 years, the overall 5-year survival rate was 92%, and the 5-year disease-free survival rate was 87%. Conclusions. The transdiaphragmatic approach to the posterior mediastinum is less aggressive than the thoracoabdominal approach. It is safe and effective for simultaneous resection of postchemotherapy testicular nonseminomatous germ cell tumors located in the retroperitoneum and posterior mediastinum.

Chest wall implantation of a mediastinal liposarcoma after thoracoscopy

We report a case of mediastinal liposarcoma resected by thoracoscopy. Despite the precautionary measures, chest wall implantations occured rapidly at the port’s sites in the chest wall and led to death within 24 months. We conclude that thoracoscopy is not a good approach for resection of anterior mediastinal masses in view of their possible malignant character.