Surgery in large anterior mediastinal mass: case series of Hospital Kuala Lumpur

Abstract

Background: Mediastinal masses comprise of a wide variety of tumors and accounts for about 3% of tumors within the chest. Very few studies have been produced so far on large anterior mediastinal masses, as this pathology is infrequently encountered in clinical practice and tend to be asymptomatic until compression symptoms occur, which leads to mediastinal mass syndrome (MMS). The aim of this writing is to assess the surgical feasibility, approach, safety of resection and outcome in large anterior mediastinal masses.Methods: A retrospective review was conducted on patients referred for mediastinal mass to the Thoracic Surgery Unit, Hospital Kuala Lumpur from October 2017 until March 2020 (30 months). Patients with evidence of primary anterior mediastinal mass measuring >6 cm on contrast-enhanced computed tomography (CECT) of thorax and had undergone treatment in our centre were included. Data were analysed by proportions, means and standard deviations. Categorical data were expressed as percentage, whereas interquartile range was used to describe continuous variables.Results: Out of 63 patients with anterior mediastinal mass, 16 (25.4%) patients had anterior mediastinal mass larger than 6 cm and was included in the analysis. The average tumor size was 11.9 cm. Five patients (31.3%) had MMS. Twelve out of 16 patients were operated with 75% rate of clear tumor margin. There was no postoperative mortality recorded within 30 days of surgery.Conclusions: Positive outcome of definitive surgery in this series suggests clinical feasibility with acceptable short-term safety. Multidisciplinary approach with adequate preoperative assessment, intraoperative preparation and short-and long-term postoperative care were key features to successful treatment of this disease.

Worsening cardiac tamponade after pericardiocentesis in a patient with anterior mediastinum mass: a case report

“…Surgical intervention such as tumour resection or debulking would be the best option for this patient. 6 , 12 , 13 A pericardiotomy could be performed to evacuate the pericardial effusion, and a tissue biopsy obtained at the same setting 19 However, this was not feasible in this case, due to the unavailability of cardiothoracic surgeon in our hospital. The second option was to treat the lymphoma with chemotherapy, provided the tissue diagnosis was obtained earlier.…”

“…5 , 8 Management of this complex condition involved a multidisciplinary joint decision-making between the anaesthetist, cardiologist, general surgeon, and emergency physician. 12 , 13 …”

“…Mediastinal masses have variable clinical presentations, and 40% of the patients are asymptomatic 9 , 10 Depending on the type of tumour and stage of presentation, definite management of mediastinal mass requires careful planning with multidisciplinary team approach. 11 , 12 , 13 The true incidence and prognosis of this condition is unknown, as some patients present with hemodynamic instability, preventing proper diagnostic work-up. 14 …”

The role of minimally invasive surgery in the management of giant mediastinal tumors: a narrative review

“…Mediastinal tumors are rare, as they account for around 3% of thoracic neoplasms ( 1 , 2 ). They include a wide range of diagnosis ( 1 , 3 ) that can present as asymptomatic findings or with different symptoms normally related to their size and their relationship with other mediastinal structures ( 3 ).…”

“…Traditionally, median sternotomy, posterolateral thoracotomy, hemi-clamshell and clamshell incisions have been considered the preferred approaches for large mediastinal masses ( 6 ) or tumors affecting vascular structures. However, with increasing experience in video-assisted thoracoscopic surgery (VATS) and, specially, with robotic-assisted thoracoscopic surgery (RATS) ( 7 , 8 ) the indications for minimally invasive surgery in these cases have considerably increased ( 2 , 4 , 9 - 12 ).…”