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Akata K, Yamasaki K, Chiba Y, Kawaguchi T, Dosaka H, Morimoto T, Higashi Y, Nishida C, Shimajiri S, Yatera K. Difficulty differentiating primary mediastinal classical Hodgkin lymphoma from inflammatory myofibroblastic tumor: A case report. Thorac Cancer 2024; 15:410-414. [PMID: 38158872 PMCID: PMC10864112 DOI: 10.1111/1759-7714.15197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024] Open
Abstract
A 20-year-old Japanese man visited our hospital because an enlarged mediastinal shadow had been detected on chest x-ray. Chest computed tomography revealed a large mediastinal mass with multiple lymph node enlargement, pericardial effusion, and bilateral pleural effusion. He was diagnosed with inflammatory myofibroblastic tumor (IMT) based on a thoracoscopic tumor biopsy. Initial corticosteroid and celecoxib treatment was only partially effective; therefore, additional tumor rebiopsy and left axillary lymph node biopsy were performed. Based on the findings, the patient was rediagnosed with classical Hodgkin lymphoma (CHL). To date, there has only been one report of a case initially diagnosed as IMT and rediagnosed as CHL, as in our case, and only three reports of malignant lymphoma mimicking IMT. When IMT is suspected based on pathological findings and subsequently with treatment failure, possible CHL and performing rebiopsy should be considered.
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Affiliation(s)
- Kentaro Akata
- Division of Infection Control and PreventionUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Kei Yamasaki
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Yosuke Chiba
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Takako Kawaguchi
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Hiroki Dosaka
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Toshiki Morimoto
- Department of Environmental Health EngineeringInstitute of Industrial Ecological Sciences, University of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Yasuyuki Higashi
- Department of Environmental Health EngineeringInstitute of Industrial Ecological Sciences, University of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Chinatsu Nishida
- Department of Environmental Health EngineeringInstitute of Industrial Ecological Sciences, University of Occupational and Environmental Health, JapanKitakyushuJapan
| | - Shohei Shimajiri
- Department of PathologyUniversity of Environmental and Occupational Health, JapanKitakyushuJapan
| | - Kazuhiro Yatera
- Department of Respiratory MedicineUniversity of Occupational and Environmental Health, JapanKitakyushuJapan
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Chun SG, Rimner A, Amini A, Chang JY, Donington J, Edelman MJ, Geng Y, Gubens MA, Higgins KA, Iyengar P, Movsas B, Ning MS, Park HS, Rodrigues G, Wolf A, Simone CB. American Radium Society Appropriate Use Criteria for Radiation Therapy in the Multidisciplinary Management of Thymic Carcinoma. JAMA Oncol 2023:2805042. [PMID: 37186595 DOI: 10.1001/jamaoncol.2023.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Importance Thymic carcinoma is rare, and its oncologic management is controversial due to a paucity of prospective data. For this reason, multidisciplinary consensus guidelines are crucial to guide oncologic management. Objective To develop expert multidisciplinary consensus guidelines on the management of common presentations of thymic carcinoma. Evidence Review Case variants spanning the spectrum of stage I to IV thymic carcinoma were developed by the 15-member multidisciplinary American Radium Society (ARS) Thoracic Appropriate Use Criteria (AUC) expert panel to address management controversies. A comprehensive review of the English-language medical literature from 1980 to 2021 was performed to inform consensus guidelines. Variants and procedures were evaluated by the panel using modified Delphi methodology. Agreement/consensus was defined as less than or equal to 3 rating points from median. Consensus recommendations were then approved by the ARS Executive Committee and subject to public comment per established ARS procedures. Findings The ARS Thoracic AUC panel identified 89 relevant references and obtained consensus for all procedures evaluated for thymic carcinoma. Minimally invasive thymectomy was rated as usually inappropriate (regardless of stage) due to the infiltrative nature of thymic carcinomas. There was consensus that conventionally fractionated radiation (1.8-2 Gy daily) to a dose of 45 to 60 Gy adjuvantly and 60 to 66 Gy in the definitive setting is appropriate and that elective nodal irradiation is inappropriate. For radiation technique, the panel recommended use of intensity-modulated radiation therapy or proton therapy (rather than 3-dimensional conformal radiotherapy) to reduce radiation exposure to the heart and lungs. Conclusions and Relevance The ARS Thoracic AUC panel has developed multidisciplinary consensus guidelines for various presentations of thymic carcinoma, perhaps the most well referenced on the topic.
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Affiliation(s)
- Stephen G Chun
- The University of Texas MD Anderson Cancer Center, Houston
| | - Andreas Rimner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Arya Amini
- City of Hope National Medical Center, Duarte, California
| | - Joe Y Chang
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - Martin J Edelman
- Fox Chase Comprehensive Cancer Center, Philadelphia, Pennsylvania
| | - Yimin Geng
- The University of Texas MD Anderson Cancer Center, Houston
| | - Matthew A Gubens
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco
| | | | - Puneeth Iyengar
- The University of Texas at Southwestern Medical Center, Dallas
| | | | - Matthew S Ning
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - George Rodrigues
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Andrea Wolf
- Mount Sinai Health System, New York, New York
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Taka M, Kobayashi S, Mizutomi K, Inoue D, Takamatsu S, Gabata T, Matsumoto I, Ikeda H, Kobayashi T, Minato H, Abo H. Diagnostic approach for mediastinal masses with radiopathological correlation. Eur J Radiol 2023; 162:110767. [PMID: 36921376 DOI: 10.1016/j.ejrad.2023.110767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE Mediastinal masses have various histopathological and radiological findings. Although lymphoma is the most common type of tumor, thymic epithelial and neurogenic tumors are common in adults and children, respectively, but several other types are difficult to distinguish. No previous review has simply and clearly shown how to differentiate mediastinal masses. METHOD We conducted a review of the latest mediastinal classifications and mass differentiation methods, with a focus on neoplastic lesions. Both older and recent studies were searched, and imaging and histopathological findings of mediastinal masses were reviewed. Original simple-to-use differentiation flowcharts are presented. RESULTS Assessing localizations and internal characteristics is very important for mediastinal mass differentiation. The mass location and affected organ/tissue should be accurately assessed first, followed by more qualitative diagnosis, and optimization of the treatment strategy. In 2014, the International Thymic Malignancy Interest Group presented a new mediastinal clinical classification. In this classification, mediastinal masses are categorized into three groups according to location: prevascular (anterior)-, visceral (middle)-, and paravertebral (posterior)-compartment masses. Then, the internal characteristics and functional images are evaluated. CONCLUSIONS Differentiation of mediastinal masses is very difficult. However, if typical imaging findings and clinical characteristics are combined, reasonable differentiation is possible. In each patient, proper differential diagnosis may contribute to better treatment selection.
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Affiliation(s)
- Masashi Taka
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Satoshi Kobayashi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Kaori Mizutomi
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Dai Inoue
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Shigeyuki Takamatsu
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Isao Matsumoto
- Department of Thoracic Surgery, Kanazawa University, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Hiroko Ikeda
- Department of Pathology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa City, Ishikawa 920-8530, Japan.
| | - Takeshi Kobayashi
- Department of Radiology, Ishikawa Prefectural Central Hospital, 2-1, Kuratsukihigashi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, 2-1, Kuratsukihigashi, Kanazawa City, Ishikawa 920-8641, Japan.
| | - Hitoshi Abo
- Department of Radiology, Toyama Prefectural Central Hospital, 2-2-78, Nishinagae, Toyama City, Toyama 930-8550, Japan.
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Jiang B, Tan Q, Deng B, Mei L, Lin Y, Zhu L. Robot-assisted thymectomy in large anterior mediastinal tumors: A comparative study with video-assisted thymectomy and open surgery. Thorac Cancer 2022; 14:267-273. [PMID: 36433677 PMCID: PMC9870738 DOI: 10.1111/1759-7714.14744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the safety and effectiveness of robot-assisted thymectomy (RAT) in large anterior mediastinal tumors (AMTs) (size ≥6 cm) compared with video-assisted thymectomy (VAT) and open surgery. METHODS A total of 132 patients with large AMTs who underwent surgical resection from January 2016 to June 2022 were included in this study. A total of 61 patients underwent RAT, 36 patients underwent VAT and 35 patients underwent open surgery. Perioperative outcomes were compared. RESULTS There were no significant differences in tumor size (p = 0.141), or pathological types (p = 0.903). Compared with the open group, the RAT and VAT groups were associated with a shorter operation time (115.00 vs. 160.00, p = 0.012; 122.50 vs. 160.00, p = 0.071), and less blood loss (50.00 vs. 200.00, p < 0.001; 50.00 vs. 200.00, p < 0.001), respectively. The rate of conversion in the RAT group was similar to that in the VAT group (6.56% vs. 13.89%, p = 0.229). Concomitant resection was less frequently performed in the VAT group than in the RAT and open groups (5.56% vs. 31.15%, p = 0.040; 5.56% vs. 31.43%, p = 0.006). VAT patients had a lower drainage volume (365.00 vs. 700.00 and 910.00 mL, p < 0.001), shorter duration of chest tube (2.00 vs. 3.00 and 4.00, p < 0.001), and shorter hospital stay (5.00 vs. 6.00 and 7.00, p < 0.001) than the RAT and open groups. There was no 30-day mortality in any group. No difference was seen in R0 resection rates (p = 0.846). The postoperative complication rates were similar among the three groups (p = 0.309). Total in-hospital costs (66493.90 vs. 33581.05 and 42876.40, p < 0.001) were significantly higher in the RAT group. CONCLUSIONS RAT is safe and effective for the resection of large AMTs compared to VAT and open surgery. Vascular resection in RAT is technically feasible. A long-term follow-up is required.
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Affiliation(s)
- Bin Jiang
- Department of Thoracic SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Qun‐You Tan
- Department of Thoracic Surgery, Daping Hospital (Army Medical Center of Chinese People's Liberation Army)Army Medical UniversityChongqingChina
| | - Bo Deng
- Department of Thoracic Surgery, Daping Hospital (Army Medical Center of Chinese People's Liberation Army)Army Medical UniversityChongqingChina
| | - Long‐Yong Mei
- Department of Thoracic Surgery, Daping Hospital (Army Medical Center of Chinese People's Liberation Army)Army Medical UniversityChongqingChina
| | - Yi‐Dan Lin
- Department of Thoracic SurgeryWest China Hospital, Sichuan UniversityChengduChina
| | - Long‐Fei Zhu
- Department of Thoracic Surgery, Daping Hospital (Army Medical Center of Chinese People's Liberation Army)Army Medical UniversityChongqingChina
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Jiang JH, Zhang Y, Gao J, Ding JY. Artificial reconstruction for a thymoma invading superior vena cava. JTCVS Tech 2022; 15:195-198. [PMID: 36276706 PMCID: PMC9579700 DOI: 10.1016/j.xjtc.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | | | - Jian-Yong Ding
- Address for reprints: Jian-Yong Ding, MD, Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
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Arrossi AV, Dermawan JK, Bolen M, Raymond D. Thymomas With Intravascular and Intracardiac Growth. Front Oncol 2022; 12:881553. [PMID: 35814455 PMCID: PMC9268891 DOI: 10.3389/fonc.2022.881553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022] Open
Abstract
Thymomas are derived from the epithelial component of the thymus and constitute the most common tumor of the anterior mediastinum. These neoplasms are considered malignant for their potential for invasion and metastases. Several histopathologic subclassification schemes have been proposed over the years, however, correlation of histotypes with prognosis remains controversial. In contrast, studies invariably have shown that staging and resection status correlate with oncologic behavior and disease outcomes. In this regard, several staging systems have been presented, though transcapsular invasion and degree of involvement of adjacent anatomic structures are common denominators of all schemes. Involvement of the great vessels and heart most commonly results from direct invasion, which may lead to unusual clinical presentations such as superior vena cava syndrome. Moreover, intravascular and intracardiac growth with or without direct mural invasion rarely occurs. We provide an overview of thymomas with intravascular and intracardiac involvement.
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Affiliation(s)
- Andrea Valeria Arrossi
- Department of Pathology, Robert J. (R.J) Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States
- *Correspondence: Andrea Valeria Arrossi,
| | - Josephine K. Dermawan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Michael Bolen
- Imaging Institute, Cardiovascular and Thoracic Radiology, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel Raymond
- Department of Thoracic Surgery, Cleveland Clinic, Cleveland, OH, United States
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Cao M, Wang Q, Yin H, Fu Y, Zhao X. Short-term analysis of uniport video-assisted thoracoscopic surgery via the subxiphoid approach without chest tube drainage for anterior mediastinal tumors: a comparative retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1687. [PMID: 34988196 PMCID: PMC8667127 DOI: 10.21037/atm-21-5790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022]
Abstract
Background Uniport video-assisted thoracoscopic surgery (VATS) via the subxiphoid approach has emerged as a safe and effective treatment for anterior mediastinal tumors. However, there is limited evidence of the necessity of chest tubes and the comparative efficacy with other approaches. Methods A total of 141 patients with anterior mediastinal tumors receiving VATS were enrolled in this retrospective study. The patients were divided into the lateral approach (LA) group, the uniport subxiphoid approach (USA) group, and the three-port subxiphoid approach (TSA) group. Short-term analysis including operation time, chest tube rates, drainage duration, visual analogue scale (VAS) score, and hospital stay were compared. Postoperative CT scans were analyzed to evaluate the amount of pleural effusion. Results There was no significant difference in demographic and baseline characteristics among the three groups (all P>0.05). The operation time, blood loss, and hospital stay of the subxiphoid approach group were significantly lower than the LA group (P<0.001). The postoperative CT scans demonstrated that the USA group had a similar amount of pleural effusion as the other groups (P=0.1605). The postoperative VAS score of the USA group was significantly lower than the other groups (P<0.001). There was no significant difference in complications, in-hospital death, and conversion to thoracotomy among the three groups (all P>0.05). Conclusions VATS via the subxiphoid approach is less invasive, equally safe, and same effective for anterior mediastinal tumors than the LA. The chest tube could be omitted for the USA.
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Affiliation(s)
- Min Cao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Wang
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hang Yin
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujie Fu
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Superior Vena Cava Reconstruction in Masaoka Stage III and IVa Thymic Epithelial Tumors. Ann Thorac Surg 2021; 113:1882-1890. [PMID: 34186095 DOI: 10.1016/j.athoracsur.2021.05.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/02/2021] [Accepted: 05/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND We present here a case series of patients who underwent resection for Masaoka Stage III and IVa Thymic Epithelial Tumors (TETs) with invasion into the superior vena cava. METHODS 29 patients with Stage III and IVa TETs were treated surgically in three institutions. Operative resections involved replacing the superior vena cava from one of the innominate veins (n=18) or via reconstruction by truncal replacement (n=2) or patchplasty (n=9). RESULTS Fifteen patients underwent neoadjuvant treatment. Thirty and 90-day mortality rate were 3.4% and 10.3%, respectively. For Stage III patients, the median overall survival and DFS were 39 and 30 months, respectively. The median overall survival and DFS in patients with Masaoka Stage IVa disease were 67 and 21 months, respectively. Undergoing only preoperative chemotherapy (p=0.007) or receiving no chemotherapy (p=0.009) had a disease-free survival that was significantly higher than receiving both pre- and postoperative chemotherapy. CONCLUSIONS SVC resection and reconstruction in Masoaka Stage III and IVa TETs can be performed with acceptable morbidity and mortality. Stage IVa patients with SVC involvement can be treated with similar results as Stage III patients with multimodality treatment.
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Mao Y, Lan Y, Cui F, Deng H, Zhang Y, Wu X, Liang W, Liu J, Liang H, He J. Comparison of different surgical approaches for anterior mediastinal tumor. J Thorac Dis 2020; 12:5430-5439. [PMID: 33209376 PMCID: PMC7656433 DOI: 10.21037/jtd-20-266] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Different 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. Methods Clinical 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. Results A 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. Conclusions Subxiphoid 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.
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Affiliation(s)
- Yong Mao
- Department of Cardiothoracic Surgery, Ningbo First Hospital, Ningbo, China
| | - Yuting Lan
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.,Mental Health College, Guangzhou Medical University, Guangzhou, China
| | - Fei Cui
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hongsheng Deng
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Yaoliang Zhang
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xi Wu
- Department of Anesthesia, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
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Liu L, Zhang J, Wang G, Guo C, Chen Y, Huang C, Li S. Extended thymectomy with blood vessel resection and reconstruction improves therapeutic outcome for clinical stage III thymic carcinoma patients: a real-world research. J Cardiothorac Surg 2020; 15:267. [PMID: 32977851 PMCID: PMC7519535 DOI: 10.1186/s13019-020-01316-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES We examine the therapeutic efficacy of extended thymectomy with blood vessel resection and reconstruction in thymic carcinoma patients with great vessel invasion. METHODS In total 26 patients diagnosed as clinical stage III thymic carcinoma with severe great vessel invasion were enrolled in this retrospective study. Among these patients, 14 cases received adjuvant chemo- and radiotherapy (non-operation subgroup, NOG), the other 12 patients received extended thymectomy with vessel resection and reconstruction followed by the adjuvant treatment (operation subgroup, OG). RESULTS All surgical procedures went smoothly with no perioperative death. R0 resection was obtained in all surgical cases, and we also observed a lymph node metastasis rate of 38.8%. The overall survival (OS) was 34 months for the whole cohort, 48 and 26 months for the OG and NOG respectively (p = 0.013). The median disease metastasis free survival (DMFS) was 47 months for the OG and 18 months for the NOG (p = 0.019). CONCLUSION Extended thymectomy with vessel resection is feasible for patients with clinical stage III thymic carcinoma. Surgery significantly improves the overall survival and the prognosis of clinical stage III thymic carcinoma.
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Affiliation(s)
- Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng district, Beijing, P.R. China
| | - Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng district, Beijing, P.R. China
| | - Guige Wang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng district, Beijing, P.R. China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng district, Beijing, P.R. China
| | - Yeye Chen
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng district, Beijing, P.R. China
| | - Cheng Huang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng district, Beijing, P.R. China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng district, Beijing, P.R. China.
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Kumar A, Pulle MV, Asaf BB, Shivnani G, Maheshwari A, Kodaganur SG, Puri HV, Bishnoi S. Superior Vena Cava Resection in Locally Advanced Thymoma-Surgical and Survival Outcomes. Indian J Surg Oncol 2020; 11:711-719. [PMID: 33299285 DOI: 10.1007/s13193-020-01204-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
This study was aimed at reporting the surgical management of superior vena cava invasion in patients with locally advanced thymoma and to evaluate surgical and survival outcomes. This is a retrospective analysis of 12 patients operated for superior vena cava resection for locally advanced thymoma over 8 years in a thoracic surgery centre in India. An analysis of peri-operative variables including complications was carried out. The influence of various predictors on survival was assessed by log-rank test. Intra-operatively, superior vena cava (SVC) alone was involved in 3 (25%) cases, SVC with BCV involvement was there in 8 cases (66.7%) and in 1 patient, the SVC involvement extended into the right atrium also. In all cases, the tumour was resected en bloc with the involved part of SVC. Repair with primary closure was sufficient in 2 cases (16.6%) in view of < 1/3rd of circumferential involvement. However, in remaining 10 cases, SVC was replaced with PTFE graft (single graft in 6 cases, Y-graft in 2 cases and twin grafts in 2 cases). No peri-operative deaths. Overall survival (OS) at 1, 3 and 5 years was 100%, 91.6% and 83.3%, respectively. Myasthenia gravis and higher Masaoka stage (IV A) of the disease were poor predictors of survival. Superior vena cava resection and reconstruction is a feasible and oncologically superior option in invasive thymoma with SVC involvement. This challenging surgical procedure should only be attempted by an experienced team of thoracic and cardiac surgeons at high-volume centre to achieve best outcomes.
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Affiliation(s)
- Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | | | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Ganesh Shivnani
- Department of Cardiac Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Arun Maheshwari
- Department of Cardiac Anaesthesia, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | | | - Harsh Vardhan Puri
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
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12
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Panda S, Irodi A, Daniel R, Chacko BR, Vimala LR, Gnanamuthu BR. Utility of cine MRI in evaluation of cardiovascular invasion by mediastinal masses. Indian J Radiol Imaging 2020; 30:280-285. [PMID: 33273761 PMCID: PMC7694725 DOI: 10.4103/ijri.ijri_69_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/10/2020] [Accepted: 06/21/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Accurate imaging assessment of cardiovascular invasion by mediastinal masses is essential for determining surgical feasibility. This can sometimes be difficult on CT owing to limited space available in the mediastinum, resulting in mediastinal masses abutting and indenting adjacent cardiovascular structures. Cine MRI may aid in such situations by demonstrating differential mobility. AIMS AND OBJECTIVES To evaluate the role of cine MRI in assessing cardiovascular invasion by mediastinal masses, by evaluating sliding motion and the presence of chemical shift artifact between the mediastinal mass and apposing structures. MATERIAL AND METHODS Retrospective study of 44 patients with mediastinal masses, with equivocal involvement of 162 cardiovascular structures on CT scan, in whom cine MRI was done. Involvement on CT was considered equivocal when there was a loss of intervening fat plane and broad surface (>3 cm) or angle (>90°) of contact between the mediastinal mass and cardiovascular structure. The presence of either sliding movement or type 2 chemical shift artifact or both between mass and the cardiovascular structure was considered as no adherence or invasion. The absence of both the parameters was considered as the presence of invasion or adhesion. Imaging findings were correlated with intraoperative findings. RESULTS After excluding 25 cardiovascular structures in 7 patients, 137 cardiovascular structures whose involvement was suspected on CT were evaluated in 37 patients with mediastinal masses. In all, 31 cardiovascular structures showed invasion on MRI out of which 28 structures were invaded or adhered intraoperatively and 106 cardiovascular structures showed no invasion on MRI out of which 97 structures were intraoperatively not invaded/adhered. The sensitivity, specificity and accuracy of our study are 75.7%, 97% and 91.2%, respectively. CONCLUSION Cine MRI can be used as an effective tool in patients with equivocal cardiovascular invasion by mediastinal masses on CT scans.
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Affiliation(s)
- Sourav Panda
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Riya Daniel
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Binita R Chacko
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Leena R Vimala
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Birla R Gnanamuthu
- Department of Cardiothoracic Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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13
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Maurizi G, D'Andrilli A, Vanni C, Ciccone AM, Ibrahim M, Andreetti C, Menna C, Poggi C, Venuta F, Rendina EA. Salvage resection of advanced mediastinal tumors. J Thorac Dis 2019; 11:S1653-S1661. [PMID: 31516738 DOI: 10.21037/jtd.2019.07.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The surgical treatment of locally advanced mediastinal tumors invading the great vessels and other nearby structures still represent a tricky question, principally due to the technical complexity of the resective phase, the contingent need to carry out viable vascular reconstructions and, therefore, the proper management of pathophysiologic issues. Published large-number series providing oncologic outcomes of patients who have undergone extended radical surgery for invasive mediastinal masses are just a few. Furthermore, the wide variety of different histologies included in some of these studies, as well as the heterogeneity of chemo and radiation therapies employed, did not allow for the development of clear oncologic guidelines. Usually in the past, surgical resections of large masses along with the neighbouring structures were not offered to patients because of related morbidity and mortality and limited information available on the prognostic advantage for long term. However, in the last decades, advances in surgical technique and perioperative management, as well as increased oncologic experience in this field, have allowed radical exeresis in selected patients with invasive tumors requiring resections extended to the surrounding structures and complex vascular reconstructions. Such aggressive surgical treatment has been proposed in association or not with adjuvant chemo- or radiotherapy regimens, achieving encouraging oncologic results with limited morbidity and mortality in experienced institutions. Congestive heart failure or impending cardiovascular collapse due to the compression by the large mass are the most frequent immediately life-threatening problems that some of these patients can experience. In this setting, medical palliation is usually ineffective and an aggressive salvage surgical treatment may remain the only therapeutic option.
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Affiliation(s)
- Giulio Maurizi
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Vanni
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Anna Maria Ciccone
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Claudio Andreetti
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Cecilia Menna
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Camilla Poggi
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Erino Angelo Rendina
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Carro SE, Essex DW, Alsammak M, Bains A, Toyoda Y, Keshavamurthy S. Mediastinal Lymphoma Presenting in Cardiogenic Shock with Superior Vena Cava Syndrome in a Primigravida at Full Term: Salvage Resection after Prolonged Extracorporeal Life Support. Case Rep Oncol 2019; 12:401-410. [PMID: 31244642 PMCID: PMC6587197 DOI: 10.1159/000499195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/19/2022] Open
Abstract
Primary mediastinal large B-cell lymphoma (PMBCL) is a rare type of non-Hodgkin lymphoma that typically has a good response rate to first line chemotherapy regimens. There have been reports of successful chemotherapy, but with a residual mass from fibrosis. Here, we report the case of a 19-year-old primigravida presenting with cardiogenic shock and superior vena cava (SVC) syndrome at full term who was found to have a PMBCL. Following delivery via urgent cesarean section, she was put on veno-arterial extra corporeal membrane oxygenation (VA-ECMO) and once hemodynamically stable was started on chemotherapy. In view of limited change in tumor size on consecutive CT scans and questionable response to chemotherapy, there were multidisciplinary meetings wherein withdrawing support was discussed and put forward to the family. At that point, surgical debulking was offered on compassionate grounds to be able to wean her off the VA-ECMO. This case report highlights the role of salvage resection when there are no other options.
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Affiliation(s)
- Sabrina E Carro
- MD Candidate 2020, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David W Essex
- Department of Hematology and Oncology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Mohamed Alsammak
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Ashish Bains
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Yoshiya Toyoda
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Suresh Keshavamurthy
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
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Zhu XS, Song N, Song NC, Sihoe ADL, He WX, Liu M, Jiang GN, Zhang P. Comparison of the perioperative outcomes in antero-superior mediastinal tumor resection performed by transcervical resection and video-assisted thoracoscopic surgery. J Thorac Dis 2019; 10:6838-6845. [PMID: 30746229 DOI: 10.21037/jtd.2018.11.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background It remains controversial that whether transcervical resection (TC) was associated with better outcomes than video-assisted thoracoscopic surgery (VATS) in the treatment of antero-superior mediastinal tumors. We aimed to compare the safety and reliability between TC and VATS. Methods Between 2010 and 2012, 80 consecutive patients underwent antero-superior mediastinal tumor resection via TC (n=31) or VATS (n=49). Perioperative outcomes were compared. A propensity score-matched analysis was performed to control the potential confounders. Results A total of 41 men and 39 women with median age of 52.5 years were enrolled. No patient died during the perioperative course. After propensity matching, TC group was associated with less intraoperative blood loss (35.1±18.7 vs. 93.7±136.1 mL, P=0.034), less postoperative drainage (65.6±76.8 vs. 335.0±154.9 mL, P<0.001), shorter length of postoperative hospital stay (3.2±1.2 vs. 4.1±1.3 days, P=0.003) and less hospitalization expense (22,252.3±4,761.7 vs. 26,514.2±4,052.8 CNY, P=0.002) compared to VATS group. One patient with VATS was converted to open surgery due to intraoperative vessels damage. The postoperative complication was null in TC group while it was 6.1% (n=3) in VATS group (P=0.279), including 1 case of prolonged chest tube drainage and 2 cases of recurrent laryngeal nerve injury. Conclusions TC for antero-superior mediastinal tumors is a safe procedure with better perioperative outcomes compared to VATS.
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Affiliation(s)
- Xin-Sheng Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Nan Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Nai-Cheng Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Alan Dart Loon Sihoe
- Department of Surgery, The Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Wen-Xin He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Ming Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Ge-Ning Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
| | - Peng Zhang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200433, China
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Maurizi G, Poggi C, D’Andrilli A, Vanni C, Ciccone AM, Ibrahim M, Andreetti C, Tierno SM, Venuta F, Rendina EA. Superior Vena Cava Replacement for Thymic Malignancies. Ann Thorac Surg 2019; 107:386-392. [DOI: 10.1016/j.athoracsur.2018.08.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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Kaba E, Özkan B, Özyurtkan MO, Ayalp K, Toker A. Superior vena cava resection and reconstruction in mediastinal tumors and benign diseases. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2018; 26:99-107. [PMID: 32082718 PMCID: PMC7018129 DOI: 10.5606/tgkdc.dergisi.2018.14292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to evaluate our results of resection and reconstruction of the superior vena cava invaded by mediastinal tumors and benign diseases. METHODS Seventeen patients (8 males, 9 females; mean age 46±17 years; range 9 to 74 years) undergoing superior vena cava resection and reconstruction due to mediastinal pathologies between September 2006 and September 2016 were retrospectively reviewed. Patients who had angioplasty with primary suturing or partial resection with stapler were excluded. Mortality and morbidity rates were analyzed based on the demographic, and intra- and postoperative measures. RESULTS Majority of patients (94%) had mediastinal tumors. Twelve patients (71%) had thymic epithelial tumors. Tubular graft interposition was performed using ringed polytetrafluoroethylene prosthesis in nine patients (53%), while patch plasty using autologous pericardium, polytetrafluoroethylene or Dacron grafts was performed in eight patients (47%). Eleven patients (65%) necessitated concomitant resections of neighboring structures. Mean length of hospital stay was 11±6 days. There was no intraoperative death. Mortality occurred in three patients (18%). Five patients (29%) developed complications. Mortality occurred commonly in elderly patients (p<0.0001). Postoperative complications were more common in patients with concomitant resections (p=0.05). Neither acute nor chronic thrombosis developed in any patients. Median survival in patients with malignant diseases was 57 months, with a oneyear and three-year probability of survival of 83% and 74%, respectively. CONCLUSION Replacement of superior vena cava should be included in the therapeutic algorithm of selected patients with mediastinal tumors and benign diseases. Mortality rates may be higher in older patients, while the need for concomitant resections may increase morbidity rates.
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Affiliation(s)
- Erkan Kaba
- Department of Thoracic Surgery, İstanbul Bilim University, Faculty of Medicine, İstanbul, Turkey
| | - Berker Özkan
- Department of Thoracic Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Oğuzhan Özyurtkan
- Department of Thoracic Surgery, İstanbul Bilim University, Faculty of Medicine, İstanbul, Turkey
| | - Kemal Ayalp
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Alper Toker
- Department of Thoracic Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, İstanbul, Turkey
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18
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Primary Stenting Is Not Necessary in Benign Central Venous Stenosis. Ann Vasc Surg 2017; 46:322-330. [PMID: 28807744 DOI: 10.1016/j.avsg.2017.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/09/2017] [Accepted: 07/17/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of this study is to evaluate central venous stenosis (CVS) etiologies and presentation within a vascular surgery practice. We evaluated endovascular treatment modalities and the patency rates of our interventions. METHODS Five-year retrospective review of endovascular intervention for CVS. Patient demographics, medical comorbidities, and variables were collected including etiology, indwelling device, previous upper extremity (UE) deep venous thrombosis, long-term UE indwelling device (defined as >30 days), malignancy status, hypercoagulable disorders, history of radiation or mediastinal fibrosis or masses, and anticoagulation and/or antiplatelet therapy. Follow-up variables included symptoms, imaging, and anticoagulation and/or antiplatelet utilization. Living patients without recent follow-up were contacted with a telephone survey regarding current symptoms. Patency was evaluated by imaging or clinically by recurrence of signs or symptoms through January 2016. RESULTS A total of 61 patients underwent attempted endovascular CVS interventions from January 2007 to 2013. Forty-seven (83%) patients had successful interventions. There were 22 (36%) end-stage renal disease (ESRD) patients. The primary etiology in 79% of patients was benign CVS secondary to an indwelling device. Eighty-nine percent of the interventions were primary angioplasty (PTA). The overall primary patency rates at 6, 12, and 24 months were 49%, 34%, and 24%, respectively. Secondary patency rates at 6, 12, and 24 months were 97%, 93%, and 88%, respectively. There were no statistical differences in demographics or outcomes in patients treated successfully with PTA or those requiring stenting. There was no statistical difference in the patency rates between ESRD and non-ESRD patients. Previous interventions were not a predictor of loss of patency. CONCLUSIONS Our study supported the rising trend of benign CVS predominantly secondary to indwelling devices. We demonstrated acceptable secondary patency with PTA alone. This study adds further support for a primary angioplasty strategy in treating benign CVS. The optimal endovascular treatment for benign CVS is still undefined.
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19
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Sunam GS, Öncel M, Ceran S, Ödev K, Yıldıran H. Giant Benign Mediastinal Masses Extending into the Pleural Cavity. Surg J (N Y) 2016; 2:e46-e50. [PMID: 28824990 PMCID: PMC5553481 DOI: 10.1055/s-0036-1584519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/16/2016] [Indexed: 10/28/2022] Open
Abstract
Introduction The aim of the study was to evaluate the results of surgery to remove huge mediastinal masses and their pathology. Surgical resection was chosen for accurate diagnosis and treatment of the huge mediastinal masses extending into the pleural cavity. Methods Records were reviewed for eight patients who had the diagnosis of huge benign mediastinal masses and who underwent operation; details of the patients and operations were recorded. Results Mean age was 34.5 (range 22 to 44) years, and male-to-female ratio was 2:6. Computed tomography and magnetic resonance imaging (MRI) were used to evaluate the location and extent of the abnormality and to characterize the tissue components of the mass. Most of the tumors were located in the posterior mediastinum. The most frequent presenting symptom was exertional dyspnea. The majority of cases underwent posterolateral thoracotomy, and complete resection was possible in seven patients. Partial resection could only be performed in one. The mean diameter of the resected masses was 15 × 10 cm. Histopathologic examination revealed 3 neurogenic tumors, 2 teratomas, 1 thymolipoma, and 1 ectopic thyroid, and 1 hemangioma. Minor complication was seen in two cases. Conclusion The presurgical thoracic MRI provided correct diagnosis along with radiologic characterization and topography. Surgery must be the preferred treatment in huge benign mediastinal masses.
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Affiliation(s)
- Güven Sadi Sunam
- Department of Thoracic Surgery, Medical Faculty, Selçuk University, Konya, Turkey
| | - Murat Öncel
- Department of Thoracic Surgery, Medical Faculty, Selçuk University, Konya, Turkey
| | - Sami Ceran
- Department of Thoracic Surgery, Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Kemal Ödev
- Department of Radiodiagnostics, Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Hüseyin Yıldıran
- Department of Thoracic Surgery, Medical Faculty, Selçuk University, Konya, Turkey
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Li WWL, van Boven WJP, Annema JT, Eberl S, Klomp HM, de Mol BAJM. Management of large mediastinal masses: surgical and anesthesiological considerations. J Thorac Dis 2016; 8:E175-84. [PMID: 27076967 DOI: 10.21037/jtd.2016.02.55] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Large mediastinal masses are rare, and encompass a wide variety of diseases. Regardless of the diagnosis, all large mediastinal masses may cause compression or invasion of vital structures, resulting in respiratory insufficiency or hemodynamic decompensation. Detailed preoperative preparation is a prerequisite for favorable surgical outcomes and should include preoperative multimodality imaging, with emphasis on vascular anatomy and invasive characteristics of the tumor. A multidisciplinary team should decide whether neoadjuvant therapy can be beneficial. Furthermore, the anesthesiologist has to evaluate the risk of intraoperative mediastinal mass syndrome (MMS). With adequate preoperative team planning, a safe anesthesiological and surgical strategy can be accomplished.
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Affiliation(s)
- Wilson W L Li
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Wim Jan P van Boven
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Jouke T Annema
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Susanne Eberl
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Houke M Klomp
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Bas A J M de Mol
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
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Wang J, Bi N, Wang X, Hui Z, Liang J, Lv J, Zhou Z, Feng QF, Xiao Z, Chen D, Zhang H, Yin W, Wang L. Role of radiotherapy in treating patients with primary malignant mediastinal non-seminomatous germ cell tumor: A 21-year experience at a single institution. Thorac Cancer 2015; 6:399-406. [PMID: 26273393 PMCID: PMC4511316 DOI: 10.1111/1759-7714.12190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 10/08/2014] [Indexed: 12/25/2022] Open
Abstract
Background The aim of this study was to investigate the clinical characteristics and outcomes of patients with primary malignant mediastinal non-seminomatous germ cell tumor (MMNSGCT) by comparing the efficacies of different treatment modalities. Methods The charts of 62 consecutive patients with MMNSGCT between 1990 and 2010 were reviewed. Analyses included Kaplan-Meier survival and Cox multivariate regression. Results There was sufficient data of 61 patients for inclusion in the study. The median age was 25 years. At diagnosis, 35 patients had tumors located in the mediastinum, 26 had lung and/or distant metastases. At a median follow-up of 47.2 months, 32 patients had died and 43 had developed progressive disease. The one, three, and five-year overall survival (OS) and progression-free survival (PFS) rates were 72.1%, 50.8%, 49.2% and 47.5%, 32.8%, 32.8%, respectively. Patients who received radiotherapy in the primary treatment regimen showed improved five-year OS (68.2% vs. 38.5%, P = 0.043), PFS (45.5% vs. 20.5%, P = 0.023), and local recurrence-free survival (LRFS) (77.3% vs. 38.5%, P = 0.003) compared with those who did not receive radiotherapy. Multivariate analysis revealed that radiotherapy was an independent prognostic factor of five-year OS (hazard ratio [HR] 0.39, P = 0.037), PFS (HR 0.42, P = 0.017), and LRFS (HR 0.31, P = 0.019). Conclusion Radiotherapy in a chemotherapy-based treatment regimen could significantly reduce local recurrence and improve survival of MMNGCT patients.
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Affiliation(s)
- Jianyang Wang
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Nan Bi
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Xiaozhen Wang
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Zhouguang Hui
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Jun Liang
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Jima Lv
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Zongmei Zhou
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Qin Fu Feng
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Zefen Xiao
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Dongfu Chen
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Hongxing Zhang
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Weibo Yin
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Luhua Wang
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
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Tong LJ, Hosgood G, Labruyère J, Bennett SL, FitzGerald L, Shiel RE. Marked cytoreduction of a lymphocyte-rich mediastinal thymoma with neoadjuvant chemotherapy in a cat. JFMS Open Rep 2015; 1:2055116915585024. [PMID: 28491357 PMCID: PMC5362842 DOI: 10.1177/2055116915585024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 11/16/2022] Open
Abstract
Case summary A 15-year-old neutered female domestic shorthair cat presented with lethargy and acute-onset dyspnoea. Thoracic computed tomography (CT) revealed a large, cranial mediastinal mass with an estimated volume of 180.7 cm3. Chemotherapy consisting of dexamethasone followed by L-asparaginase, prednisolone, vincristine and doxorubicin was commenced owing to the severity of disease and initial possibility of lymphoma. A diagnosis of lymphocyte-rich thymoma was made based upon histological examination, positive pancytokeratin staining, variable lymphocyte CD3 expression and T cell receptor gamma polyclonality. Thoracic CT performed 35 days after the commencement of chemotherapy showed a marked reduction in the size of the mass, with an estimated volume of 9.4 cm3. A median sternotomy and thymectomy were performed. No clinical signs have recurred 34 months after surgery. Conclusions and relevance The response to chemotherapy in this case was unusual, and is likely associated with the high non-neoplastic lymphoid component of the mass. The case demonstrates that preoperative chemotherapy can be used to reduce thymoma volume prior to surgery, potentially decreasing anaesthetic risk.
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Affiliation(s)
- Linda J Tong
- Murdoch University Veterinary Hospital Murdoch, Western Australia, Australia
| | - Giselle Hosgood
- Murdoch University Veterinary Hospital Murdoch, Western Australia, Australia
| | | | - Susan L Bennett
- Murdoch University Veterinary Hospital Murdoch, Western Australia, Australia
| | - Louise FitzGerald
- Murdoch University Veterinary Hospital Murdoch, Western Australia, Australia
| | - Robert E Shiel
- Murdoch University Veterinary Hospital Murdoch, Western Australia, Australia
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Ratbi MB, El Oueriachi F, Arsalane A, El Hammoumi MM, Kabiri EH. Surgery of benign neurogenic tumors in adults: single institution experience. Pan Afr Med J 2014; 19:288. [PMID: 25870743 PMCID: PMC4391890 DOI: 10.11604/pamj.2014.19.288.4929] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 08/13/2014] [Indexed: 11/11/2022] Open
Abstract
The objective of this work is to review retrospectively our experience with 17 patients presenting with benign neurogenic tumors, managed in the department of thoracic surgery, Mohamed V Military Academic Hospital, Rabat, Morocco. Between 2003 and 2011, seventeen patients were surgically treated for benign neurogenic tumors of the mediastinum, among 112 mediastinal tumors operated during the same period. The mean age of the 17 patients was 46 years, including 11 females and 6 males. The information about clinical presentation, diagnostic procedures, surgical techniques and postoperative follow-up were extracted and analyzed from medical records. Symptoms related to the tumor were found in 13 patients (76,4%). The posterior mediastinum was the principal location (16 cases: 94%). Intraspinal extension was shown through MRI in one case. Surgical extirpation was complete in all patients. There were no tumor-related deaths and no significant complications. There were 13 schwannomas, 2 neurofibromas and 2 ganglioneuromas. Neurogenic tumors of the mediastinum in adults are mostly benign. Their only treatment is surgical extirpation. Video-assisted thoracoscopic resection is currently the best approach in selected patients.
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Affiliation(s)
- Moulay Brahim Ratbi
- Department of Visceral Surgery, Mohamed V Military Academic Hospital, Rabat, Morocco
| | - Fayçal El Oueriachi
- Department of Thoracic Surgery, Mohamed V Military Academic Hospital, Rabat, Morocco
| | - Adil Arsalane
- Department of Thoracic Surgery, Mohamed V Military Academic Hospital, Rabat, Morocco
| | | | - El Hassane Kabiri
- Department of Thoracic Surgery, Mohamed V Military Academic Hospital, Rabat, Morocco
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Inzirillo F, Giorgetta C, Ravalli E. Nerve-sparing schwannoma removal from two infrequent origins. Asian Cardiovasc Thorac Ann 2014; 23:493-5. [PMID: 24939915 DOI: 10.1177/0218492314539951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Schwannomas of nerve sheath origin (Schwann cell) are the most common neurogenic thoracic tumors and they usually originate from an intercostal nerve, especially in the paravertebral region. Tumors that originate from other nerves such as the phrenic nerve, vagus, or sympathetic nerves are uncommon. We report two cases of schwannomas in rare locations. A 62-year-old woman had a giant schwannoma arising from the right phrenic nerve, and a 57-year-old woman had one from the left sympathetic nerve. Both tumors were completely removed with preservation of the nerves.
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Affiliation(s)
| | | | - Eugenio Ravalli
- Department of Thoracic Surgery, Morelli Hospital, Sondalo, Italy
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25
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Coiffard B, Elharrar X, Vandemoortele T, Laroumagne S, Dutau H, Astoul P. The hypermetabolic mushroom: superior vena cava syndrome. Am J Med 2014; 127:395-7. [PMID: 24508415 DOI: 10.1016/j.amjmed.2014.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 01/30/2014] [Accepted: 01/30/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Benjamin Coiffard
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France.
| | - Xavier Elharrar
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Thomas Vandemoortele
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France; Department of Pulmonology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Quebec, Canada
| | - Sophie Laroumagne
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France; Aix-Marseille University, Marseille, France
| | - Hervé Dutau
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France; Aix-Marseille University, Marseille, France
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Nakano T, Endo S, Kanai Y, Otani S, Tsubochi H, Yamamoto S, Tetsuka K. Surgical outcomes after superior vena cava reconstruction with expanded polytetrafluoroethylene grafts. Ann Thorac Cardiovasc Surg 2013; 20:310-5. [PMID: 23801179 DOI: 10.5761/atcs.oa.13-00050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Graft occlusion is a problem after superior vena cava (SVC) reconstruction for thoracic malignancy. Expanded polytetrafluoroethylene (ePTFE) is considered to be an optimal material for venous reconstruction. METHODS We reviewed the hospital records of 13 patients who underwent complete resection of thoracic malignancy invading the SVC, including SVC reconstruction with ePTFE grafts. Single bypass grafting was performed in two patients (one right-sided, one left-sided) and double bypasses grafting was performed in the other patients. All patients received antithrombotic therapy after surgery. Eight patients died of recurrence or other disease during the follow-up period (range 5-41 months). RESULTS Of the 24 grafts in 13 patients, graft patency was confirmed in 20 grafts in 9 patients at a mean time follow-up time of 47.8 ± 50.0 months after surgery. In the remaining four grafts in four patients, occlusion was diagnosed at a mean time of 1.25 ± 0.50 months after surgery. All obstructed grafts were left-sided bypass grafts in patients who underwent double bypass grafting, and did not result in SVC syndrome. CONCLUSIONS SVC reconstruction with ringed ePTFE grafts was safe and had good outcomes. In patients who underwent double bypasses grafting, the left-sided bypass grafts were susceptible to occlusion.
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Affiliation(s)
- Tomoyuki Nakano
- Department of General Thoracic Surgery, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan
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27
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Billè A, Garofalo G, Leo F, Pastorino U. Giant liposarcoma elongating mediastinal vessels with intrathoracic inferior vena cava replacement. Eur J Cardiothorac Surg 2013; 44:570-2. [DOI: 10.1093/ejcts/ezt149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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28
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Fukumoto K, Takatsuki S, Jinzaki M, Yamada M, Tanimoto K, Nishiyama N, Aizawa Y, Hagiwara Y, Fukuda Y, Kimura T, Miyoshi S, Kuribayashi S, Fukuda K. Three-dimensional imaging and mapping of the right and left phrenic nerves: relevance to interventional cardiovascular therapy. ACTA ACUST UNITED AC 2013; 15:937-43. [DOI: 10.1093/europace/eus439] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Anterior mediastinal tumours include primary and secondary tumours. Patients may be asymptomatic or present with symptoms related to local tumour invasion or systemic symptoms due to release of hormones/cytokines or antibodies. The most common symptoms at presentation include chest pain, dyspnoea, cough, fever and chills. Despite rapid developments in imaging techniques, accurate staging of anterior mediastinal tumours remains a diagnostic quandary. Multimodality imaging plays an important role in determining surgical resectability and/or impact on subsequent management. This article briefly discusses the epidemiology and incidence of anterior mediastinal tumours and describes the role of imaging in tumour characterization and staging in detail. We focus on the more commonly encountered anterior mediastinal tumours.
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Affiliation(s)
- Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital, 1E Kent Ridge Road, Singapore
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30
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Durkovic S, Di Chiara F, Rea F. Prosthetic azygo-atrial bypass for palliation of superior vena cava syndrome. Eur J Cardiothorac Surg 2012; 41:e56-8. [DOI: 10.1093/ejcts/ezr289] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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31
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De Latour B, Fadel E, Mercier O, Mussot S, Fabre D, Fizazi K, Dartevelle P. Surgical outcomes in patients with primary mediastinal non-seminomatous germ cell tumours and elevated post-chemotherapy serum tumour markers. Eur J Cardiothorac Surg 2012; 42:66-71; discussion 71. [DOI: 10.1093/ejcts/ezr252] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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32
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Venuta F, Rendina EA, Klepetko W, Rocco G. Surgical management of stage III thymic tumors. Thorac Surg Clin 2011; 21:85-91, vii. [PMID: 21070989 DOI: 10.1016/j.thorsurg.2010.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thymic tumors are classified as stage III when they clearly invade the surrounding structures: pericardium, great vessels (superior vena cava, innominate veins, ascending aorta, and main pulmonary artery), lung parenchyma, phrenic nerves, and chest wall. Surgical treatment with or without induction therapy should always aim to complete resection removing en bloc all the involved structures. Also, extended procedures are justified because only R0 resection allows long-term survival.
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Affiliation(s)
- Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, Cattedra di Chirurgia Toracica, Viale del Policlinico, 00166 Rome, Italy.
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33
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Perentes JY, Erling CC, Ris HB, Corpataux JM, Magnusson L. A simple bypass technique for superior vena cava reconstruction☆. Interact Cardiovasc Thorac Surg 2011; 12:15-9. [DOI: 10.1510/icvts.2010.247205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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34
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Affiliation(s)
- Umar Imran Hamid
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK.
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35
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Reply to Anile et al. Lung Cancer 2010. [DOI: 10.1016/j.lungcan.2010.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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36
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Bellamy J. [Conservative management of the phrenic nerve and surgical treatment of lung cancer]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:167-172. [PMID: 20561481 DOI: 10.1016/j.pneumo.2009.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 11/01/2009] [Accepted: 12/16/2009] [Indexed: 05/29/2023]
Abstract
Bronchial carcinoma may involve the phrenic nerve, confronting the surgeon with a difficult choice. In 10 patients undergoing surgery for bronchial carcinoma without previous diaphragmatic palsy, extension to the nerve was discovered during the thoracotomy, leading to a choice between radical surgery involving resection of the nerve, with subsequent diaphragmatic palsy, or incomplete conservative resection preserving the lung function. Conservative surgery was chosen. The subsequent evolution validated this choice. However, the paucity of papers on such cases, although they are not outstandingly unusual, should be noted.
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Affiliation(s)
- J Bellamy
- Hôpital privé Claude-Galien, Quincy-sous-Sénart, France.
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37
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D'Andrilli A, Venuta F, Rendina EA. Surgical Approaches for Invasive Tumors of the Anterior Mediastinum. Thorac Surg Clin 2010; 20:265-84. [DOI: 10.1016/j.thorsurg.2010.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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38
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Trousse D, Avaro JP. [Mediastinal tumors: introduction]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:3-16. [PMID: 20207291 DOI: 10.1016/j.pneumo.2009.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/17/2009] [Indexed: 05/28/2023]
Abstract
Mediastinal tumors are relatively uncommon, usually incidentally discovered on a chest X-ray in asymptomatic patients. Young adults are particularly concerned. Mediastinal masses represent a group of heterogeneous histological type cell. A definite diagnosis is essential leading to an adequate prompt therapeutic strategy when either benign disease or aggressive malignant tumor is conceivable. Indeed the therapeutic management of such tumors could be strictly medical, requiring exclusive surgical approach or includes a multimodal treatment. Clinical examination and imaging are important tools in the diagnostic approach. However the specific diagnosis could be complex and requires histological confirmation by an experienced pathologist after examination of large biopsies of the tumor. Several investigations, including surgical invasive exploration, should be quickly requested in order to achieve a final diagnosis and refer patients in an adequate therapeutic scheme without delay. The aim of this article is to point out the available diagnostic tools in mediastinal masses, including surgical approach, and to identify the role of surgical resection in specific subtypes.
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Affiliation(s)
- D Trousse
- Service de Chirurgie Thoracique et Maladies de l'Oesophage, Hôpital Sainte-Marguerite, Université de la Méditérranée, 270 boulevard Sainte-Marguerite, 13274 Marseille cedex 9, France.
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39
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Gross JL, Rosalino UAC, Younes RN, Haddad FJ, Silva RAD, Rocha ABMA. Characteristics associated with complete surgical resection of primary malignant mediastinal tumors. J Bras Pneumol 2009; 35:832-8. [PMID: 19820808 DOI: 10.1590/s1806-37132009000900003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 05/15/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify preoperative characteristics associated with complete surgical resection of primary malignant mediastinal tumors. METHODS Between 1996 and 2006, 42 patients with primary malignant mediastinal tumors were submitted to surgery with curative intent at a single facility. Patient charts were reviewed in order to collect data related to demographics, clinical manifestation, characteristics of mediastinal tumors and imaging aspects of invasiveness. RESULTS The surgical resection was considered complete in 69.1% of the patients. Cases of incomplete resection were attributed to invasion of the following structures: large blood vessels (4 cases); the superior vena cava (3 cases); the heart (2 cases); the lung and chest wall (3 cases); and the trachea (1 case). Overall survival was significantly better among the patients submitted to complete surgical resection than among those submitted to incomplete resection. The frequency of incomplete resection was significantly higher in cases in which the tumor had invaded organs other than the lung (as identified through imaging studies) than in those in which it was restricted to the lung (47.6% vs. 14.3%; p = 0.04). None of the other preoperative characteristics analyzed were found to be associated with complete resection. CONCLUSIONS Preoperative radiological evidence of invasion of organs other than the lung is associated with the incomplete surgical resection of primary malignant mediastinal tumors.
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40
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Chan LP, Chiang FY, Lee KW, Kuo WR. Carcinoma showing thymus-like differentiation (CASTLE) of thyroid: a case report and literature review. Kaohsiung J Med Sci 2009; 24:591-7. [PMID: 19239992 DOI: 10.1016/s1607-551x(09)70020-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Carcinoma showing thymus-like differentiation (CASTLE) is a rare malignant neoplasm that occurs in the thyroid gland, or head and neck. This tumor arises from either ectopic thymus tissue or remnants of branchial pouches, which retain the potential to differentiate along the thymus line. Clinical presentation and imaging can be consistent with a malignant lesion such as thyroid cancer or thymic carcinoma. Immunohistochemical staining with CD5 can differentiate CASTLE from other malignant thyroid neoplasms. A 54-year-old male had initially presented with a painless, left neck mass for 3 months. He underwent left thyroid lobectomy via a median sternotomy approach. Carcinoma showing thymus-like differentiation was the final histopathologic diagnosis. After 36 months of follow-up, no evidence of recurrence was observed. A median sternotomy is an excellent approach for CASTLE with anterior mediastinum involvement. Complete resection is important to improve the long-term survival rate and the locoregional recurrence rate.
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Affiliation(s)
- Leong-Perng Chan
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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41
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42
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Garcia A, Flores RM. Surgical Management of Tumors Invading the Superior Vena Cava. Ann Thorac Surg 2008; 85:2144-6. [DOI: 10.1016/j.athoracsur.2007.12.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 12/06/2007] [Accepted: 12/10/2007] [Indexed: 11/16/2022]
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43
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Radical Excision of Thymic Adenocarcinoma with Selective Cerebral Perfusion. Ann Thorac Surg 2008; 85:1427-9. [DOI: 10.1016/j.athoracsur.2007.10.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Revised: 10/19/2007] [Accepted: 10/23/2007] [Indexed: 11/19/2022]
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44
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Greillier L, Dutau H, Astoul P. [Specific emergencies in thoracic oncology: pleurisy, superior vena cava syndrome, and tracheobronchial obstruction]. REVUE DE PNEUMOLOGIE CLINIQUE 2008; 64:69-75. [PMID: 18589286 DOI: 10.1016/j.pneumo.2008.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In patients with lung cancer, the appearance of pleurisy, superior vena cava syndrome, or tracheobronchial obstruction are complications that require specialized care, often in an emergency context. Our objective is to present the different therapeutic options available in each of these three complications and to suggest recommendations on the care to provide in everyday clinical practice.
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Affiliation(s)
- L Greillier
- Pôle Cardiovasculaire et Thoracique, Université de la Méditerranée, Hôpital Sainte-Marguerite, 270 Boulevard Sainte-Marguerite, 13009 Marseille, France
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45
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Akkersdijk GP, van Geel AN. Blindness: a rare and serious complication after extensive mediastinal resection. Ann Thorac Surg 2008; 85:1426-7. [PMID: 18355542 DOI: 10.1016/j.athoracsur.2007.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 09/25/2007] [Accepted: 10/02/2007] [Indexed: 11/29/2022]
Abstract
We describe the case of a patient in whom blindness developed as a result of superior vena cava syndrome after resection of a primary mediastinal nonseminomatous germ cell tumor.
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Affiliation(s)
- George P Akkersdijk
- Department of Vascular Surgery, Erasmus Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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46
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Kang CH, Kim YT, Jheon SH, Sung SW, Kim JH. Surgical Treatment of Malignant Mediastinal Nonseminomatous Germ Cell Tumor. Ann Thorac Surg 2008; 85:379-84. [DOI: 10.1016/j.athoracsur.2007.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 09/07/2007] [Accepted: 09/10/2007] [Indexed: 11/30/2022]
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47
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Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med 2007; 356:1862-9. [PMID: 17476012 DOI: 10.1056/nejmcp067190] [Citation(s) in RCA: 257] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lynn D Wilson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA.
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48
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Debulking surgery for advanced thymoma. Eur J Surg Oncol 2006; 32:1000-5. [DOI: 10.1016/j.ejso.2006.03.049] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 03/31/2006] [Indexed: 11/16/2022] Open
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49
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Ríos A, Torres J, Roca MJ, Galindo PJ, Alonso JL, Parrilla P. [Primary thymic lymphomas]. Rev Clin Esp 2006; 206:326-31. [PMID: 16831379 DOI: 10.1157/13090480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Primary thymic lymphomas (PTLs) are uncommon, and their prognosis is linked with early treatment. A review is carried out of this disease in our hospital in order to determine the best diagnostic-therapeutic management for these patients. MATERIAL AND METHODS Ten LPTs--four Hodgkin's and six non-Hodgkin's (4 primary mediastinal B lymphomas [PMBLs] and 2 lymphoblastic T lymphomas [LTLs]--were reviewed. Most of the patients were females, with a mean age of 23 +/- 10 years. RESULTS The initial diagnostic suspicion in the Hodgkin's lymphomas was thymoma in two cases and lymphoma in the other 2. All of them underwent surgery, including an intra-operative biopsy, which was completed with a thymectomy in the two in which thymoma was reported. They were treated with radio and chemotherapy. The response was partial in two cases, and treatment was completed with a bone marrow transplant (BMT) (one died and the other had active disease). The non-Hodgkin's lymphomas had large tumors and short evolution. All of them received surgery, with an intra-operative biopsy in four and a thymectomy in two. They were treated with chemotherapy, with associated radiotherapy in two. The response was total in three, with two recurring, who are in complete remission after a BMT. In the other three the response was partial. CONCLUSIONS In a patient with thymic tumour with a preoperative or intraoperative study suspected of having a lymphoma, it is necessary to do a biopsy and not resective surgery, to avoid unnecessary resections and morbidity. PTLs are uncommon but aggressive, principally the non-Hodgkin's lymphomas. The main treatment is radio and chemotherapy, with associated bone marrow transplantation in selected cases.
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Affiliation(s)
- A Ríos
- Departamento de Cirugía, Servicio de Cirugía Torácica, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Espana.
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50
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Erdös G, Kunde M, Tzanova I, Werner C. Anästhesiologisches Management bei mediastinaler Raumforderung. Anaesthesist 2005; 54:1215-28. [PMID: 16091923 DOI: 10.1007/s00101-005-0895-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The perioperative management of patients with mediastinal masses is a special clinical challenge in our field. Even though regional anaesthesia is normally the first choice, in some cases it is not feasible due to the method of operation. In these cases general anaesthesia is the second option but can lead to respiratory and haemodynamic decompensation due to tumor-associated compression syndrome (mediastinal mass syndrome). The appropriate treatment begins with the preoperative risk classification on the basis of clinical and radiological findings. In addition to anamnesis, chest radiograph, and CT, dynamical methods (e.g. pneumotachography and echocardiography) should be applied to verify possible intraoperative compression syndromes. The induction of general anaesthesia is to be realized in awake-fiberoptic intubation with introduction of the tube via nasal route while maintaining the spontaneous breathing of the patient. The anaesthesia continues with short effective agents applied inhalative or iv. If possible from the point of operation, agents of muscle relaxation are not to be applied. If the anaesthesia risk is classified as uncertain or unsafe, depending on the location of tumor compression (tracheobronchial tree, pulmonary artery, superior vena cava), alternative techniques of securing the respiratory tract (different tubes, rigid bronchoscope) and cardiopulmonary bypass with extracorporal oxygen supply are prepared. For patients with severe clinical symptoms and extensive mediastinal mass, the preoperative cannulation of femoral vessels is also recommended. In addition to fulfilling technical and personnel requirements, an interdisciplinary cooperation of participating fields is the most important prerequisite for the optimal treatment of patients.
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Affiliation(s)
- G Erdös
- Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Langenbeckstrasse 1, 55131 Mainz.
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