Characteristics associated with complete surgical resection of primary malignant mediastinal tumors

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 (3cases); 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.Keywords: Thoracic surgery; Survival rate; Mediastinal neoplasms; Diagnostic imaging. ResumoObjetivo: Identificar características pré-operatórias associadas à ressecção cirúrgica completa de tumores malignos primários do mediastino. Métodos: Entre os anos de 1996 e 2006, 42 pacientes com tumores malignos primários do mediastino foram submetidos a tratamento cirúrgico com intenção curativa em uma única instituição. Dados demográficos, manifestações clínicas, características do tumor mediastinal e aspectos de invasão por métodos de imagem foram identificados através da análise de prontuários. Resultados: A ressecção cirúrgica foi considerada completa em 69,1% dos pacientes. As causas de ressecção incompleta foram atribuídas à invasão das seguintes estruturas: grandes vasos (4 casos); veia cava superior (3 casos); coração (2 casos); pulmão e parede torácica (3 casos); e traqueia (1 caso). Os pacientes que foram submetidos à ressecção cirúrgica completa tiveram sobrevida global significativamente melhor que os pacientes submetidos à ressecção incompleta. A frequência de ressecção incompleta foi significativamente maior nos casos nos quais foram identificadas características radiológicas de invasão de outros órgãos além do pulmão do que nos casos cujas características eram restritas ao pulmão (47,6% vs. 14,3%; p = 0,04). Nenhuma das outras características pré-operatórias analisadas foi associada com a ressecção cirúrgica completa. Conclusões: Evidências radiológicas de invasão de órgãos além do pulmão no pré-operatório estão associadas à ressecção cirú...

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