Surgery For Mediastinal Tumors Research Articles

Impact of the expanded indication of robot-assisted thoracic surgery for mediastinal tumors.

Following the introduction of robot-assisted thoracoscopic surgery (RATS) as a health insurance-covered treatment in Japan, we investigated the current status and impact of the expansion of the indications for RATS for mediastinal tumors. Between 2018 and 2022, 209 cases of total mediastinal tumor resection were performed in our hospital. The study period was divided into the first half (January 2018 to June 2020) and the second half (July 2020 to December 2022), and perioperative parameters were compared between the two groups. Ninety-six surgical procedures were performed in the first half and 113 in the second half. The percentage of RATS approach was significantly higher in the second half compared with the first half (P < 0.001). Indications for RATS in the second half compared with the first half were significantly increased in patients with stage II (P < 0.001) and stage III (P = 0.026) thymomas, tumor diameter ≥ 50mm (P < 0.011), and patients undergoing extended thymectomy for myasthenia gravis (P < 0.009). In respect of short-term postoperative parameters, the estimated intraoperative blood loss (P < 0.035), postoperative drain duration (P < 0.037), and postoperative hospital stay (P < 0.011) were significantly lower in the second half than in the first half. RATS has recently been expanded for mediastinal tumors with improved short-term outcomes in our hospital after health insurance was applied in Japan. In the future, it will be necessary to discuss the further expansion of its indications by taking into account safety and long-term outcomes.

Cardiac Tamponade Caused By Carbon Dioxide Insufflation During Robot-Assisted Thoracic Surgery: A Case Report.

Various complications can occur during robot-assisted thoracic surgery for mediastinal tumors owing to carbon dioxide (CO2) insufflation. This study reports the case of a 43-year-old woman who underwent robot-assisted surgery for an anterior mediastinal tumor with the subxiphoid approach. Shortly after starting CO2 insufflation, the blood pressure decreased significantly. Subsequent examination of the mediastinum revealed a left-sided pericardial injury. Cardiac tamponade due to entry of CO2 gas into the pericardial cavity was suspected. A deliberate incision was made in the right pericardium, ultimately resolving the cardiac tamponade and substantially improving the patient's blood pressure.

Surgery for mediastinal teratoma containing pancreatic tissue

Surgery for mediastinal tumors is still one of the most difficult in modern medicine. This is due to vital organs and various nature of tumors in this area. Teratomas are relatively rare among mediastinal tumors. However, they have certain features that is important for treatment strategy and management of possible complications. This can complicate diagnostic algorithm, exclude transthoracic biopsy and contribute to active surgical approach even for benign process. Oncogenesis of teratoma has its own characteristics. Tissues of different organs are always present in this tumor. Among these, pancreatic tissue inclusions are rare. A few data in the world literature on the treatment of such patients do not allow to develop a universally accepted algorithm of diagnosis and treatment. The authors present two patients with mediastinal teratoma. The second patient had teratoma with pancreatic tissue. The authors discuss the diagnostic algorithm for similar cases. A special attention is paid to description of possible complications throughout long-term follow-up period. Surgical aspects including the choice of access and local spread of process (adhesions in the area of surgical interest) are considered. The report on the treatment of two patients with rare mediastinal tumors containing pancreatic tissue will be useful for primary care physicians, thoracic surgeons, oncologists and morphologists.

Anterior mediastinal tumor surgery applying single-port thoracoscopy using the subxiphoid approach.

This study aims to investigate the effectiveness of application of single-port thoracoscopy using the subxiphoid approach in anterior mediastinal tumor surgery. Between June 2014 and June 2016, a total of 108 patients (59 males, 49 females; mean age: 64.9±7.5 years; range, 45 to 79 years) with anterior mediastinal tumors were randomized into subxiphoid (experimental) or right chest (control) groups. Single-port thoracoscopy using the subxiphoid approach was performed in the subxiphoid group, while thoracoscopy using the right thoracic approach was performed in the control group. Preand postoperative pain stress indicators, Visual Analog Scale scores, quality of life scores, postoperative tumor recurrence, and five-year survival rates were compared between the groups. There were no mortality or serious complications in either group. The mean Visual Analog Scale pain scores on postoperative Days 1 and 7 were 6.5±0.8 and 2.9±0.8 in the subxiphoid group, respectively, compared to 7.2±0.8 and 3.4±0.8 in the control group (p<0.05 for all), respectively. The mean quality of life scores on postoperative Days 1 and 7 were 81.5±5.0 and 79.3±7.7, respectively, in the subxiphoid group compared to 72.4±4.3 and 71.3±4.8 in the control group, respectively (p<0.05 for all). Postoperative pain and pain mediator indexes were lower in the subxiphoid group (p<0.05 for all). The postoperative tumor recurrence rates were 3.70% and 20.37% in the subxiphoid and control groups, respectively (p=0.008). The five-year survival rates were 85.2% and 63.0% in the subxiphoid and control groups, respectively (p=0.008). Single-port thoracoscopy using the subxiphoid approach is technically feasible, safe, and effective in performing surgery for anterior mediastinal tumors with an intact capsule and a tumor diameter of ≤5 cm.

The anesthetic management and the role of extracorporeal membrane oxygenation for giant mediastinal tumor surgery.

Mediastinal tumors are a remarkably diverse category. They include malignant and benign forms with different rates of disease progression and tissue invasion. Anesthesiologists may encounter significant difficulties in managing patients with giant mediastinal tumors due to the non-negligible occurrence of severe cardiorespiratory collapse. Respiratory complications ensue from the compression of the airways induced by the mediastinal mass: the compressive effects may be exacerbated by positioning or anesthesia induction. Furthermore, the compression or invasion of major vessels may elicit acute cardiovascular collapse. The specter of sudden cardiorespiratory deterioration should lead the anesthesiologist to careful planning: acknowledging clinical and radiological signs that may presage an increased risk of life-threatening complications is of pivotal importance. This review aims to present a strategy for treating patients with mediastinal masses, starting with the pathophysiological elements and moving through preoperative care, intraoperative behavior, and the recovery period. We will also focus on respiratory and cardiovascular issues, emphasizing the need for extracorporeal membrane oxygenation (ECMO) as a rescue and crucial component of the anesthesia strategy. Understanding the physiological alterations after anesthesia induction can aid in identifying and treating potential problems. In addition, we attempted to offer insight into multimodal anesthesia and analgesia management: we emphasize the importance of a thorough preoperative assessment and the need for reviewing extracorporeal support not just a resuscitative strategy but as an integrated component of the perioperative care.

Application of computer-assisted surgery in pediatric mediastinal tumor surgery.

Computer-assisted Surgery system (CAS) is an effective medical imaging simulation tool, which is widely used in preoperative planning of surgery. The objective of this study is to investigate the clinical application of CAS in pediatric mediastinal tumor resection. This retrospective study investigated 74 children who underwent mediastinal tumor resection between June 2008 and June 2022 at the pediatric surgical center of the Affiliated Hospital of Qingdao University and Qingdao Women and Children's Hospital. Preoperative chest computed tomography imaging was performed on all children. A total of 44 children (the CAS-assisted group) underwent clinical image 3D reconstruction and preoperative simulation using Hisense CAS. The control group consisted of 30 children who underwent a conventional procedure without CAS. The demographic, preoperative, and complication data were analyzed and compared between the two groups. t-test, Mann-Whitney U test, X2 test, or Fisher's exact test were used accordingly in this study during analysis. The median operative duration was 119.00min in the CAS-assisted group and 140.50min in the control group. The median intraoperative blood loss of the CAS-assisted group and the control group was 14.00 and 31.00ml respectively. Relative to the control groups, the CAS-assisted group experienced shorter operative duration time (p=0.041), and less intraoperative blood loss (p<0.001). The difference in postoperative drain indwelling between the CAS-assisted group (median:4.00days) and the control group (median:7.00days) reached a statistical significance (p=0.001). And the duration of hospitalization after the operation for the CAS-assisted group (median:7.00days) was shorter than that for the control group (median:9.00days) (p=0.001). No significant difference could be found in the rate of blood transfusion (p=0.258) and the incidence of postoperative complications (p=0.719) between the two groups. Hisense CAS could effectively assist surgeons to clearly determine the anatomical site of tumors and provide accurate preoperative simulation for surgeons, so as to assist surgeons to specify effective surgical plans for patients.

Single-port robotic surgery for mediastinal tumors using the da vinci SP system: Initial experience.

Studies of single-port robot-assisted thoracic surgery (RATS) using the da Vinci SP system, which uses a smaller surgical incision than the conventional multiport robot, have yet to be reported because of its smaller operating range. We report our initial experience using the da Vinci SP system in thoracic surgery for the resection of mediastinal tumors that requires a smaller workspace. Two patients diagnosed with superior mediastinal tumors underwent RATS performed with the da Vinci SP surgical system in January 2022. We used three-dimensional reconstruction to preoperatively determine the surgical incision. This is the first report of single-port RATS using the SP system in China. R0 resection was achieved in both operations without complications. Operation times and bleeding volumes were similar to the use of multiport RATS. No perioperative complications occurred. The da Vinci SP system can be used for the resection of superior mediastinal tumors. Case selection and preoperative planning should be performed prior to these surgeries.

Artificial pneumothorax suppresses postoperative inflammatory reaction in mediastinal tumor surgery.

The induction of artificial pneumothorax has many intraoperative advantages. However, few reports on the postoperative effects of artificial pneumothorax induction are available. In this study, we investigated the effect of artificial pneumothorax on postoperative clinical course in patients with mediastinal tumors. We retrospectively investigated the clinical courses of 89 patients who had undergone mediastinal tumor resection between January 2010 and December 2020. Sixty-five patients had undergone resection with artificial pneumothorax. The tumor location significantly varied across patients. The proportion of patients in whom artificial pneumothorax was induced was higher among those having anterior mediastinal tumors. The number of ports and the total skin incision length were significantly higher in patients without artificial pneumothorax. The C-reactive protein level elevation on postoperative day 2 and pleural effusion at 24h after surgery were significantly higher in patients without artificial pneumothorax. Furthermore, the albumin level reduction and hospital stay after surgery were significantly lower in patients with artificial pneumothorax. Multiple regression analysis showed that the use of artificial pneumothorax was an independent predictive factor of the C-reactive protein level elevation on postoperative day 2 and pleural effusion at 24h after surgery. In patients without artificial pneumothorax, the operation time positively correlated with the C-reactive protein level (r = 0.646, P < 0.001). Artificial pneumothorax suppressed the postoperative inflammatory response, pleural effusion, and albumin reduction, and shortened the hospital stay in patients undergoing mediastinal tumor surgery.

A technique of revascularization in mediastinal tumor surgery with superior vena cava resection

A technique of revascularization in mediastinal tumor surgery with superior vena cava resection

Comparison of different surgical approaches for anterior mediastinal tumor.

BackgroundDifferent video-assisted thoracoscopic surgery (VATS) approaches may related to heterogeneous clinical outcomes in anterior mediastinal tumor surgery. Herein, we assessed the comparison between the subxiphoid and intercostal approach, and also compare the left versus the right incision in the intercostal approach for anterior mediastinal tumor patients.MethodsClinical data of patients receiving thoracoscopic anterior mediastinal tumor resection were retrospectively collected. Patients were divided into two groups according to the approaches: subxiphoid and the intercostal group. The intercostal group was further subdivided into two groups according to different sides: left and right incision group. Intraoperative and postoperative variables were compared between subgroups.ResultsA total of 238 patients were consecutively included in this analysis; 198 (83.2%) patients received intercostal procedure and 40 (16.8%) patients received subxiphoid approach. After 1:1 propensity score matching, all baseline characters were well balanced between intercostal and subxiphoid approach, left and right intercostal approach. The visual analogue scale (VAS) pain score was lower in patients underwent subxiphoid approach than intercostal group at first post-operative evaluation in 12–24 h (4.36 vs. 2.23; P=0.03). According to left and right approach, postoperative drainage time (1.9 vs. 1.2 days, P=0.016), postoperative drainage volume (312.1 vs. 193.9 mL, P=0.041) and hospitalization time (5.3 vs. 4.1 days, P=0.043) were significantly increased in the left thoracic approach group compared with the right thoracic approach.ConclusionsSubxiphoid approach is associated with less pain compared with intercostal approach. The right intercostal thoracic approach may offer better clinical effect of short-term postoperative recovery.

Comparison of efficacy between video-assisted thoracoscopic surgery and thoracotomy in children with mediastinal tumors: 6-year experience

Video-assisted thoracic surgery (VATS) has been increasingly used in pediatric patients. We evaluated the outcomes of VATS and thoracotomy for pediatric mediastinal tumors. A total of 137 patients who underwent surgery for mediastinal tumors at our department from March 2012 to September 2018 were recruited in this retrospective study. Forty-three patients were treated by VATS and ninety-four underwent thoracotomy (two patients who underwent open surgery were excluded from the study because they were lost to follow-up). Data including demographic information, tumor characteristics, operative time, conversion of surgery, blood transfusion, postoperative hospital stay, mortality and recurrence were collected and compared between the two groups. No significant difference was found in gender, age, weight and tumor distribution between the two groups. The number of patients with malignant tumors who underwent thoracotomy was significantly higher than those who received VATS (78.0% vs. 22.0%, P=0.04). Patients received thoracotomy had significantly larger mean tumor diameter than those who underwent VATS (7.6±3.8 vs. 4.4±1.7 cm, P<0.001). The intraoperative transfusion rate in the thoracotomy group was significantly higher than that in the VATS group (67.4% vs. 14.0%, P<0.001), so was the amount of blood transfusion (148.1±150.7 vs. 23.3±61.1 mL, P<0.001). The VATS group had significantly shorter operative time as compared with the thoracotomy group (94.3±40.9 vs. 133.5±72.1 min, P=0.002). During follow-up, local recurrence was found in 8 (8.7%) patients who underwent thoracotomy, and no significant difference was found in local recurrence rate between the two groups. Four patients who underwent thoracotomy died, and no significant difference was found in mortality between two groups. Due to less blood transfusion, shorter operative time and postoperative hospital stay, VATS is a safer surgical treatment for pediatric mediastinal tumors than thoracotomy.

Nonintubated Spontaneous Ventilation Offers Better Short-term Outcome for Mediastinal Tumor Surgery

Nonintubated spontaneous ventilation video-assisted thoracoscopic surgery (NI-VATS) has been investigated to reduce the adverse effects of tracheal intubation, mechanical ventilation, and general anesthesia in several thoracic diseases. We comparatively assess the comparison between NI-VATS vs intubated anesthesia VATS (I-VATS) on early outcomes of mediastinal lesion resection. Patients who underwent VATS resection for a mediastinal tumor between December 2015 and September 2018 were retrospectively included for analysis. Patients were divided into two groups according to anesthesia ventilation type: NI-VATS and I-VATS. Propensity score matching was applied to eliminate population bias. Intraoperative and postoperative variables were compared. A total of 198 patients was included; 75 patients underwent NI-VATS and 123 patients underwent I-VATS. After propensity score matching, both anesthesia time (173.81 vs 227.37 minutes, P < .001) and operation time (82.82 vs 133.49 minutes, P < .001) were shorter in the NI-VATS group. Bleeding (51.80 mL vs 56.73 mL, P= .90) and postoperative morbidity (10.9% vs 15.6%, P= .57) were similar between groups. Chest tube duration (1.11 vs 1.54 days, P= .04) was shorter in the NI-VATS group. Hospital duration after surgery (3.15 vs 5.35 days, P < .001) was shorter in the NI-VATS group. D-dimer after surgery was significantly higher in both groups, but NI-VATS decreased the change (577 vs 1624 μg/L, P < .001). Furthermore, a decrease in the use of postoperative opioids analgesics was seen in the NI-VATS group (31% vs 51%, P= .023). Mediastinal tumor resection is safe and feasible under NI-VATS. Better short-term outcomes suggest NI-VATS facilitates a more rapid recovery. Further multicenter prospective randomized investigation is warranted.

Management of hemorrhage during thoracoscopic surgery for anterior mediastinal tumors

Recently, thoracoscopic surgery for mediastinal tumors has become a frequent procedure but is generally associated with more difficult management of hemorrhage than open surgery; therefore, extra care is needed for ensuring safety. The criterion for determining whether endoscopic surgery is indicated for an anterior mediastinal tumor is based on whether the tumor can be safely dissected from the left brachiocephalic vein. The range of applications differs depending upon the surgical approach selected. Because it is difficult to clamp this vessel when the patient is in the lateral decubitus position, surgery should be performed with the patient in the supine position, which allows for conversion to median sternotomy regardless of the endoscopic surgery approach being used. In cases in which the anterior mediastinal tumor is suspected to have invaded and in contact with the left brachiocephalic vein, dissection of the tumor from the brachiocephalic vein is required. If thoracoscopic hemostasis is deemed difficult, then swiftly convert to median sternotomy without any hesitation or delay, and safely performing the procedure is of utmost importance. Any minimally invasive surgical procedure must maintain the same or better precision than that in its open surgery counterpart and must consider patient safety.

Single site robotic surgery for thoracic diseases

Robotic-assisted thoracic surgery has gained widespread acceptance for various thoracic diseases owing to its surgical accuracy. With recent advances in robotic-surgery devices, the single-site approach has become possible in robotic surgery. Herein, we report the case of single-site robotic surgery for mediastinal tumors by the thoracic approach. We performed robotic surgery with single-site instruments in a 50-year-old male with a mediastinal tumor in the anterior mediastinum. The instruments used were an 8.5-mm endoscope, 5-mm curved non-wristed instruments, and an accessory tracer on the 3-cm-diameter single-port device for the single-site robotic system. The potential benefits of this approach to thoracic surgery are better surgical accuracy and the enhanced operative field of robotic surgery, as well as the potential benefits of single-port thoracoscopic surgery.

Preoperative embolization to reduce morbidity and mortality in hypervascular mediastinal tumor surgery

Preoperative embolization to reduce morbidity and mortality in hypervascular mediastinal tumor surgery

Robotic surgery for mediastinal tumors

BACKGROUND: The surgical approach to mediastinal tumors has changed during the last two decades. Median sternotomies and thoracotomies have been replaced in part by minimally invasive procedures. Aim of this review is to highlight applications of a robotic-assisted approach in mediastinal tumor surgery. METHODS: Review of the current literature. RESULTS: A robotic approach for thymectomy, anterior mediastinal mass resection, pericardial cyst resection, diagnostic sampling of enlarged lymph nodes in the middle mediastinum, resection of benign neurogenic tumors in the posterior mediastinum and esophageal procedures was shown to be feasible. Postoperative outcomes as well as the contraindications and limitations of a robotic approach are discussed. CONCLUSIONS: For appropriate indications minimal invasive surgery with a surgical robot can safely be performed for tumors in the anterior, middle, and posterior compartments of the mediastinum.

Pericardial Cyst or Teratoma? Change of Strategy during Mediastinal Tumor Surgery

This report describes the management of an 8 × 8-cm cystic mass that arose from the anterior mediastinum and prolapsed into the right pleural cavity adherent to the pericardium in an asymptomatic 16-year-old girl. The patient was scheduled for a video-assisted thoracoscopic operation with exposure, puncture and suction of a suspected pericardial cyst. However, during the procedure the strategy was changed due to the solid consistency of the mass, and the lesion was extirpated in toto by a short anterolateral thoracotomy. The complete histopathological investigation showed a highly fibrous, cystic, mature teratoma.

Resection of a Posterior Mediastinal Metastasis of Colon Cancer

We report a resection of a posterior mediastinal metastasis of colon cancer. A 29-year-old man who had undergone a right hemicolectomy and liver resection for ascending colon cancer with liver metastasis was referred to our hospital with the diagnosis of a solitary posterior mediastinal metastasis. Tumor extirpation with descending aorta replacement was performed. Five months after the operation, local recurrence developed in the posterior mediastinum, which was also resected. He has been recurrence-free for 5 years since the second procedure. In this case, the metastases were believed to have occurred through the thoracic duct.

Digit-assisted thoracoscopic surgery for mediastinal tumors: A novel technique

Digit-assisted thoracoscopic surgery (DATS) is a novel, minimally invasive approach for achieving a superior mediastinal mass, by allowing the surgeon's finger to pass into the superior mediastinum through a suprasternal route. In this study a DATS procedure for a bronchogenic cyst in the superior mediastinum was performed. The procedure worked well for dissecting the tissue around the mass, and thus reduced the effort required to perform the operation. In the current study DATS was found to be superior to the standard technique.

INTRATHORACIC EXTRAMEDULLARY HEMATOPOIESIS SIMULATING MEDIASTINAL TUMOR IN A CASE OF HEMOLYTIC ANEMIA (SPHEROCYTOSIS)

Intrathoracic extramedullary hematopoiesis simulating mediastinal tumor in a 64-year-old female with hemolytic anemia (spherocytosis) is reported.The patient was admitted to the Ryukyu University Hospital on August 26, 1986 for mediastinal tumor surgery. Her past medical history revealed that 10 years prior to admission, she had been operated on for gallstones. At that time she had been diagnosed as having hemolytic anemia (spherocytosis). On admission, the chest X-ray showed a right mediastinal tumor. CT studies of the chest demonstrated a large hyperdense mass (49.7 HU) arising from the right paravertebral space and extending from the 6th to the 12th paravertebral body with well-defined margins. The tumor was 8.5×8.5×4.5 cm in size and 60 g in weight. It appeared as a redbrown encapsulated soft mass mimicking hemangioma. Histologically, it was composed of extensive hematopoietic tissue and sparse fatty tissue.The patient's postoperative course was uneventful. Her Hgb was 8.6 mg/dl on discharge, and returned to 10.6 mg/dl one year later.