Management of large mediastinal masses: surgical and anesthesiological considerations

Li, Wilson W.L.; Boven, Wim Jan P. van; Annema, Jouke T.; Eberl, Susanne; Klomp, Houke M.; Mol, Bas A.J.M. de

doi:10.21037/jtd.2016.02.55

Cited by 64 publications

(86 citation statements)

References 72 publications

(79 reference statements)

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“…For those whose tumor body breaks through the thoracic outlet to the neck, a "T" shaped incision should be made through the median sternum combined with neck collar incision. When lobectomy or wedge-shaped resection of the lung is needed, posterolateral thoracotomy may be selected for the tumor located in one side mediastinum, large tumor, lung invasion and pericardium [6,11,12]. In our group from Imaging, 73 patients had estimated adhesions with surrounding tissues, and 35 patients had clear boundaries with surrounding tissues.…”

Section: Discussionmentioning

confidence: 90%

Surgical treatment of benign mediastinal teratoma: summary of experience of 108 cases

Tian

Liu

et al. 2020

J Cardiothorac Surg

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Background: Mediastinal teratoma is a rare disease, many cases were reported before, but few articles focus on large case analyses. The objective of this article is to summarize the clinical characteristics of benign mediastinal teratoma and the experience of surgical treatment, especially thoracoscopic surgery for benign mediastinal teratoma. Methods: The clinical data of 108 patients with benign mediastinal teratoma confirmed by operation and pathology from January 1992 to January 2018 were analyzed retrospectively. The clinical symptoms, imaging examination, surgical methods and prognosis of all patients were analyzed. We compared the difference of thoracoscopic surgery and thoracotomy surgery using 102 patients underwent only chest surgery. Normally distributed continuous variables were compared by independent sample t test. Categorical variables were analyzed by chi-square test. Results: Imaging examination showed that all 108 cases of mediastinal teratoma were located in the anterior region of mediastinum. All cases underwent surgical resection, postoperative pathology confirmed that all cases were benign. 1 case was taken simple neck collar incision, 5 case was taken median thoracotomy combined with neck incision, other 102 cases were taken thoracoscopic surgery (22) or thoracotomy surgery (80). 4 cases were treated with partial pericardial resection due to adhesions, 12 cases underwent partial pericardial resection, 5 cases underwent lobectomy, 9 cases underwent wedge resection of lobe, and 2 patients underwent anonymous vein angioplasty. 1 case underwent second operation because of postoperative bleeding, 1 case of chylothorax, 1 case of recurrent laryngeal nerve injury, 2 cases of wound infection, 1 case of secondary pulmonary infection. 106 cases were followed up, period from 12 months to 10 years, no recurrence of tumor was found. Comparing to take thoracotomy surgery, patients underwent thoracoscopic surgery has strong advantage on intraoperative blood loss and hospital stay days after surgery (P < 0.05). tumor maximum diameter is larger for thoracotomy surgery group, as well as more patients suffer estimated adhesions from preoperative imaging. so we compared above parameters in patients with tumor diameter less than 10 cm with or without estimated adhesions from preoperative imaging, a strong advantage still can be found in thoracoscopic surgery group, inpatients with estimated adhesions from preoperative imaging, intraoperative blood loss (38.75 ± 15.53 vs 169.17 ± 208.82., P = 0.04) and hospital stay days after surgery (5.50 ± 0.93 vs 9.43 ± 6.54., P = 0.04) were better. In patients without estimated adhesions from preoperative imaging, intraoperative blood loss (46.67 ± 10.00 vs 110.53 ± 123.13., P = 0.06) and hospital stay days after surgery (4.70 ± 1.16 vs 7.53 ± 2.32., P = 0.01) were better. Especially, in thoracoscopic surgery group, hospital stay days after surgery was significantly shorter. Conclusion: The clinical manifestations and imaging performance of benign mediastinal teratoma were ...

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Section: Discussionmentioning

confidence: 90%

Surgical treatment of benign mediastinal teratoma: summary of experience of 108 cases

Tian

Liu

et al. 2020

J Cardiothorac Surg

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“…In addition, it has been found to have a partial obstructive respiratory effect and large negative pressures by flattening the trachea through extrinsic compression, muscular relaxation, and active airway inspiratory force disturbance, causing the chest wall volume and external support of narrowed airway to reduce. Other factors such as the supine position, the elimination of glottic regulation of airflow by endotracheal intubation, and the size and location of the mediastinal mass, as well as the existence of obstructive or restrictive preexisting airway diseases could contribute to the airway collapse [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…In summary, patient suffering from central airway compression by an anterior mediastinal mass requires a preoperative anesthetic planning in coordination between the anesthetist and the surgeon in charge, in order to prevent possible perioperative and postoperative complications [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Tracheal Obstruction Management among Patients with Anterior Mediastinal Masses

Kafrouni

Saroufim

Massih

2018

Case Reports in Medicine

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Background Patients suffering from undiagnosed obstruction of the central airways: the trachea and main stem bronchi are at increased risk for perioperative and postoperative complications, especially if general anesthesia is performed. Case Description This report discusses a 30-year-old asymptomatic Caucasian female who faced recurrent distal airway collapse during mediastinoscopy for biopsy of an anterior mediastinal mass, which led to the inability to extubate her. This case examines the necessity of a thorough preoperative assessment especially in patients with undiagnosed tracheal obstruction and a precise coordination between anesthesiologist and surgeon in being able to perform a safe and smooth anesthesia, in order to avoid life-threatening complications and to reduce further morbidity. Methods The scope of this case report is restricted to publications in all surgical and anesthesiological specialties among adult patient population. Main search key words were as follows: “tracheal obstruction,” “general anesthesia,” “mediastinum,” and “tumors” Results. The literature supports an increased perioperative risk of airway obstruction with the use of general anesthesia in patients with anterior mediastinal masses. This case report suggests a perioperative anesthetic management modality for patients presenting with anterior mediastinal masses and who are at high risk of cardiovascular compression and tracheal obstruction. Thus, it is highly important to note that evidence-based recommendations are not available in the literature. Conclusions This case report suggests perioperative management modalities performed by anesthesiologists in order to minimize the risk of airway obstruction among patients having anterior mediastinal masses and shed the lights on the importance of proper anesthetic and surgical planning in order to prevent intraoperative complications and improve the quality of healthcare provided to patients presenting critical cases.

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“…VATS is actually considered the surgical approach of choice for diagnosing and resecting tumors smaller than 7 cm without signs of malignancy since it has better outcomes in terms of surgical procedure, amount of blood loss, length of drainage time, and length of hospital stay [6] [7]. Midline approaches through sternotomy or transmanubrial approach are alternatives that secure an adequate visual field and enable the safe separation of blood vessels and nerves from the tumor [8]; however, anterior approaches will generally not provide adequate exposure for masses located deep in the posterior mediastinum or that extend below the level of the pulmonary hilum [9].…”

Section: Discussionmentioning

confidence: 99%

The Transcervical Extended Access, a Feasible Approach for the Surgical Treatment of Benign Tumors of the Posterior Mediastinum?

Pérez¹,

Hernández²,

Cano³

et al. 2018

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Transcervical approach for tumors of the posterior mediastinum is traditionally thought not to be indicated. Hereby we report on a case of a patient with a huge neurogenic tumor of the posterior mediastinum which was successfully excised through a transcervical extended approach and, additionally, the variety of surgical approaches used to remove tumors of the posterior mediastinum is discussed. The new refined techniques of transcervical extended mediastinal operations, which are recently gaining popularity among surgeons, allowed for a safe dissection of the tumor, thus patient could benefit from a short painless postoperative course. The authors suggest that surgeons trained in these particular techniques should consider the choice of the transcervical extended access in selected cases of benign tumors of the posterior mediastinum.

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Management of large mediastinal masses: surgical and anesthesiological considerations

Cited by 64 publications

References 72 publications

Surgical treatment of benign mediastinal teratoma: summary of experience of 108 cases

Surgical treatment of benign mediastinal teratoma: summary of experience of 108 cases

Intraoperative Tracheal Obstruction Management among Patients with Anterior Mediastinal Masses

The Transcervical Extended Access, a Feasible Approach for the Surgical Treatment of Benign Tumors of the Posterior Mediastinum?

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