Comparison of VATS and Thoracotomy Results in Mediastinal Neurogenic Tumors

Abstract

Objective In this study, we aimed to compare the results of patients who underwent surgery by thoracotomy and Video-assisted thoracoscopic surgery (VATS) in mediastinal neurogenic tumors. Materials and Methods Twenty-six consecutive cases (12 males and 14 females; mean age 39.4 ± 22.3 years; range 1–72 years) who were histopathologically diagnosed as having mediastinal neurogenic tumors between January 2000 and August 2020 were included in a single-center, retrospective study. Results There were 5 (19.2%) children and 21 (80.8%) adults. Lesions in all cases were located in the posterior mediastinum. Schwannoma was detected histopathologically in 18 cases (69.2%), and all of these cases were adult patients. Resection was performed by thoracotomy in 14 cases (7 right and 7 left) and 12 cases by thoracoscopy (7 right and 5 left). The mean tumor size was 7.4 ± 1.9 cm (range 5–12 cm) in the thoracotomy group and 4.3 ± 1.9 cm (range 2–7 cm) in the VATS group ( P = .001). Mean operative time was 101.7 ± 27.8 min (range 70–150 min) in the thoracotomy group and 77.9 ± 24.3 min (range 60–150 min) in the VATS group ( P = .014). Mean postoperative hospital stay was 7.4 ± 4.0 days (range 3–20 days) in the thoracotomy group and 4.7 ± 1.7 days (range 2–7 days) in the VATS group ( P = .040). Conclusion Most of the mediastinal neurogenic tumors are benign and surgical resection is required in their treatment. With increasing experience, resection can be performed thoracoscopically in most cases.

A single‐center study of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors

“…Previous studies suggested that endoscopic surgery was not suitable for children <6 months old, weight <8 kg, tumor/chest index (tumor diameter/tumor horizontal chest diameter) >0.5, tumor diameter >8cm, and tumors located at the costophrenic angle, top of chest, and neck–thorax junction. 11 , 12 However, with the gradual refinement of minimally invasive surgery and anesthesia, the scope for minimally invasive technology has increased. In this study, mediastinal masses located at the top of the chest and the junction of the neck and chest as well as mediastinal tumors with diameters up to 11 cm were successfully resected by thoracoscopic surgery.…”

“… Children with tumor/chest index (tumor diameter/tumor horizontal chest diameter) ≤0.5 can be selected for surgery. 12 , 13 , 14 For children with tumor/chest index ≥0.5, thoracoscopic surgery is not absolutely suitable. The specific tumor characteristics, such as location at the relatively superficial position of the mediastinum, towards one side in the chest or with no important organ coating on its surface, will determine whether or not thoracoscopic surgery can be attempted (Figure 3a,b ).…”

“…There is no uniform standard for thoracoscopic indications. Previous studies suggested that endoscopic surgery was not suitable for children <6 months old, weight <8 kg, tumor/chest index (tumor diameter/tumor horizontal chest diameter) >0.5, tumor diameter >8cm, and tumors located at the costophrenic angle, top of chest, and neck–thorax junction 11,12 . However, with the gradual refinement of minimally invasive surgery and anesthesia, the scope for minimally invasive technology has increased.…”

“…Selecting the most appropriate patient candidates can improve the chance of thoracoscopic surgery success, and reduce the proportion of conversion to thoracotomy and unnecessary trauma 13,14 . Our findings regarding patient selection are the following: Thoracoscopic surgery can be successfully completed for mediastinal neurogenic masses with tumor size less than 10 cm. Children with tumor/chest index (tumor diameter/tumor horizontal chest diameter) ≤0.5 can be selected for surgery 12–14 . For children with tumor/chest index ≥0.5, thoracoscopic surgery is not absolutely suitable.…”