Three different surgical methods for large-sized anterior mediastinal tumors in real-world practice.

Autor: Wang L; Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China. 1507144@zju.edu.cn., Liu J; Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China., Xu W; Department of Cardiothoracic Surgery, The Sanmen People's Hospital, Taizhou, 318000, China., Tang M; Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China., Wang Y; Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China., Lv W; Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China., Xia P; Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China., Zhu L; Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China. Linhai_zhu@zju.edu.cn., Hu J; Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou, 310003, China. dr_hujian@zju.edu.cn.; Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, Hangzhou, 310003, China. dr_hujian@zju.edu.cn.
Jazyk: angličtina
Zdroj: BMC cancer [BMC Cancer] 2024 Nov 29; Vol. 24 (1), pp. 1475. Date of Electronic Publication: 2024 Nov 29.
DOI: 10.1186/s12885-024-13255-w
Abstrakt: Background: Video-assisted thoracoscopic surgery (VATS) for a relatively large mediastinal tumor (5.0-10.0 cm) remains controversial. In addition, few studies have focused on comparing different surgical approaches for large mediastinal tumors. Therefore, this study aimed to compare the short-term outcomes between subxiphoid approach VATS, intercostal approach VATS, and traditional sternotomy for large-sized anterior mediastinal tumors.
Methods: The study consecutively enrolled 159 patients with large-sized anterior mediastinal tumors (5.0-10.0 cm) who received surgery in our hospital between January 2018 and July 2022 (subxiphoid approach VATS: 52 patients, intercostal approach VATS: 70 patients, traditional sternotomy: 37 patients). We analyzed the clinical baseline data, intraoperative and postoperative outcomes, and postoperative complications of all patients. Then the patients were further divided into two groups according to whether there was a peripheral organ (such as pericardium, lung, or left innominate vein) invasion: group A, invasion of the surrounding organ, and group B, no invasion of the surrounding organ. Intraoperative and postoperative outcomes and postoperative complications were also analyzed in group A and group B, respectively.
Results: In all patients, there were significant differences in blood loss (subxiphoid approach: 33.1 ± 46.0 ml, intercostal approach: 36.9 ± 44.1 ml, sternotomy: 113.0 ± 84.9 ml, P < 0.001) and duration of postoperative oral analgesics (subxiphoid approach: 3.4 ± 0.9 d, intercostal approach: 3.7 ± 1.4 d, sternotomy: 4.5 ± 1.5 d, P = 0.002) among the three methods. In group A, there was a significant difference in blood loss (subxiphoid approach: 50.0 ± 67.7 ml, intercostal approach: 90.0 ± 66.6 ml, sternotomy: 157.9 ± 90.2 ml, P < 0.001) among the three methods. In group B, there were significant differences in the duration of postoperative oral analgesics (subxiphoid approach: 3.2 ± 0.8 d, intercostal approach: 3.7 ± 1.4 d, sternotomy: 4.2 ± 1.1 d, P < 0.05) and blood loss (subxiphoid approach: 22.5 ± 19.3 ml, intercostal approach: 31.9 ± 38.5 ml, sternotomy: 65.6 ± 44.9 ml, P < 0.001) between the three methods. There were no significant differences in the postoperative complications.
Conclusions: VATS is an effective, minimally invasive, and safe procedure for large-sized anterior mediastinal tumors (5.0-10.0 cm) without an invasion of the surrounding organs, and maybe a feasible and secure method for large-sized anterior mediastinal tumors with an invasion of the surrounding organ (such as the pericardium, lung, or left innominate vein). Subxiphoid approach VATS is a less invasive procedure than intercostal approach VATS and traditional sternotomy due to its reduced blood loss and postoperative pain.
Competing Interests: Declarations. Ethical approval: This study was approved by the Clinical Research Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (2022 IIT No. 1166), and kept in accordance with the Declaration of Helsinki (as revised in 2013) and Good Clinical Practice Guidelines. Written informed consent was obtained from patients so that we could utilize their medical record information. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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