Analysis of giant thoracic neoplasms: Correlations between imaging, pathology and surgical management

Abstract

BackgroundA giant thoracic neoplasm is extremely rare and poorly understood. Our systemic study introduced computed tomography angiography (CTA) with three‐dimensional (3D) reconstruction imaging and evaluated correlations between imaging, pathology, and surgical management.MethodsData from 45 patients undergoing surgery for giant thoracic neoplasm in our institution between May 2007 and November 2015 were collected. The clinical characteristics, imaging manifestations, preoperative biopsy, surgical management, postoperative pathology, and prognosis and their correlation were analyzed.ResultsThe clinical characteristics, imaging manifestations, and pathological types were complicated. Four patients underwent CTA with 3D reconstruction imaging and feeding vessels were found in three cases. Twenty‐four selected patients accepted preoperative biopsy, eight of which were inconsistent with postoperative pathology. Complete resection was performed in 39 cases, 20 of which underwent extended excision. The median survival duration of all patients was 58 months (range 3.0–118.0). The one, three, and five‐year survival rates were 86.0%, 64.4%, and 47.0%, respectively. Univariate analyses showed tumor size and resection status were prognostic factors for survival (P = 0.003 and P < 0.001, respectively).ConclusionsA giant thoracic neoplasm should preferably be treated in experienced centers for precise diagnosis and optimal therapy schemes with comprehensive consideration of clinical characters, imaging manifestations, pathology, surgical management, and prognosis. Innovative CTA with 3D reconstruction imaging together with preoperative biopsy are feasible and effective in therapeutic decision‐making and surgical planning. Complete surgical resection remains the mainstay of curative therapy for all resectable tumors.

Cardiopulmonary bypass does not consequentially contribute to postoperative distant metastasis of giant refractory thoracic tumors: A retrospective study with long‐term follow‐up

“…However, most giant refractory thoracic tumors seriously invade important mediastinal tissues and organs. 11 , 12 The postoperative recurrence rate is extremely high and the prognosis is poor when surgeons cannot completely remove the tumors using conventional thoracic surgery. 13 As expected, the two patients with major resection in the present study both suffered from local recurrence.…”

“… 16 , 17 , 18 , 19 These risks limit the implementation of conventional thoracic surgery. Preoperative multidisciplinary consultation, detailed assessment of the positional relationship between the tumor and the surrounding tissues and organs, 11 , 20 careful management of the anesthetic process, 19 and active use of CPB or extracorporeal membrane oxygenation (ECMO) can all help thoracic surgeons to effectively overcome surgical difficulties in order to reduce the risk of the operation 5 , 21 and achieve a complete removal of tumor tissues with better prognosis. 5 , 22 …”