Surgical strategy for giant mediastinal mass_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Lianyong ¹ , SHEN Saie ² , MEI Ju ¹ , WANG Mingsong ¹ , XIAO Haibo ¹ , HU Fengqing ¹ , HU Rui ¹ , LI Guoqing ¹ ,  XIE Xiao ¹

1. Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, P.R.China;
2. Department of Anesthsiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, P.R.China;

Corresponding author：

XIE Xiao, Email: doctorxiexiao@126.com

Keywords：

Mediastinal mass; giant mass; surgical operation; anesthesia management

DOI：

10.7507/1007-4848.201611015

Video：

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Objective To introduce the surgical and perioperative strategy for giant mediastinal mass. Methods The clinical data of 21 patients with giant mediastinal mass who underwent surgical treatment in Xinhua Hospital of Shanghai from January 2007 to July 2016 were retrospectively reviewed. There were 14 males and 7 females, with a mean age of 34.62 ± 22.95 years (range: 11 months to 79 years), and mean weight of 58.07±22.24 kg (range: 10.8 to 90.5 kg). Their clinical manifestation, anesthesia methods, surgical treatment and the prognosis were analyzed. Results The tumor volume ranged from 8 cm×6 cm×6 cm to 25 cm×25 cm×8 cm. For surgical approach, 12 patients received median sternotomy, 5 anterior lateral incision, 1 posterior lateral incision, 2 "L"-shape sternotomy, 1 cervical and thoracic "]"-shape incision. All patients were given mass radical resection, except one patient with two-stage resection. Twelve patients needed other tissues resection besides the single tomor resection. The operation time was 55-480 (207.86±87.67) min, blood loss volume 700 (10-4 000) ml, intraoperative blood transfusion 800 (0-4 100) ml, postoperative mechanical ventilation time 4.75 (0-87) h, postoperative drainage time 3-12 (7.43±2.66) d, the total drainage volume 295-4 940 (1 584.76±1 173.98) ml, average daily drainage volume 62-494 (204.90±105.76) ml, and postoperative hospital stay 7-47 (11.86±8.51) d. The postoperative complications included pericardial effusion in 1 patient, Horner syndrome in 1, left recurrent laryngeal nerve injury with the left phrenic nerve injury in 1, right phrenic nerve injury in 1 and delayed wound healing in 1. The remaining patients recovered well. All patients were followed up for 1 month to 9 years. Till September 1, 2016, 5 patients died and 2 suffered recurrent tumor. Conclusion It is safe to perform surgical treatment after comprehensive evaluation of patients with giant mediastinal mass, perioperative mortality is low, and prognosis in patients with benign tumor is good.

Citation： JIANG Lianyong, SHEN Saie, MEI Ju, WANG Mingsong, XIAO Haibo, HU Fengqing, HU Rui, LI Guoqing, XIE Xiao. Surgical strategy for giant mediastinal mass. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(10): 753-759. doi: 10.7507/1007-4848.201611015 Copy

1.	Keon TP. Death on induction of anesthesia for cervical biopsy. Anesthesiology, 1981, 55(4): 471-472.
2.	Lin CM, Hsu JC. Anterior mediastinal tumour identified by intraoperative transesophageal echocardiography. Can J Anaesth, 2001, 48(1): 78-80.
3.	Al-Sanouri I, Shaban M, Al-Shahid M, et al. A 21-year-old woman with mediastinal mass and cardiac arrest. BMJ Case Rep, 2013, 19: 1-4.
4.	许林, 沈振亚. 巨大纵隔肿瘤的外科治疗. 实用临床医药杂志, 2007, 11(3): 53-54.0.
5.	Marchevsky AM. Mediastinal tumors of peripheral nervous system origin. Semin Diagn Pathol, 1999, 16(1): 65-78.
6.	Webb WR, Gatsonis C, Zerhouni EA, et al. CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. Radiology, 1991, 178(3): 705-713.
7.	Biederer J, Mirsadraee S, Beer M, et al. MRI of the lung (3/3)-current applications and future perspectives. Insights Imaging, 2012, 3(4): 373-386.
8.	Rena O, Filosso PL, Papalia E, et al. Solitary fibrous tumor of the pleura: surgical treatment. Eur J Cardiothorac Surg, 2001, 19(2): 185-189.
9.	Béchard P, Létourneau L, Lacasse Y, et al. Perioperative cardiorespiratory complications in adults with mediastinal mass: incidence and risk factors. Anesthesiology, 2004, 100(4): 826-834.
10.	Slinger P, Karsli C. Management of the patient with a large anterior mediastinal mass: recurring myths. Curr Opin Anaesthesiol, 2007, 20(1): 1-3.
11.	Cardillo G, Faccilo F, Cavazzana AO, et al. Localized (solitary) fibrous tumors of the pleura: an analysis of 55 patients. Ann Thorac Surg, 2000, 70(6): 1808-1812.
12.	Kaul P, Kay S, Gaines P, et al. Giant pleural fibroma with an abdominal vascular supply mimicking a pulmonary sequestration. Ann Thorac Surg, 2003, 76(3): 935-937.
13.	Chao YK, Liu YH, Hsieh MJ, et al. Controlling difficult airway by rigid bronchoscope-an old but effective method. Interact Cardiovasc Thorac Surg, 2005, 4(3): 175-179.
14.	Wiseman O, Preston PG, Clarke JM. Presentation of thyroid carcinoma as a thrombosed external jugular vein, with intraluminal tumour thrombus in the great veins. Eur J Surg Oncol, 2000, 26(8): 816-817.
15.	Inoue M, Minami M, Shiono H, et al. Efficient clinical application of percutaneous cardiopulmonary support for perioperative management of a huge anterior mediastinal tumor. J Thorac Cardiovasc Surg, 2006, 131(3): 755-756.
16.	Anderson DM, Dimitrova GT, Awad H. Patient with posterior mediastinal mass requiring urgent cardiopulmonary bypass. Anesthesiology, 2011, 114(6): 1488-1493.
17.	Li WW, van Boven WJ, Annema JT. et al. Management of large mediastinal masses: Surgical and anesthesiological considerations. J Thorac Dis, 2016, 8(3): E175-E184.
18.	Wada N, Masudo K; Hirakawa S, et al. Superior vena cava (SVC) reconstruction using autologous tissue in two patients of differentiated thyroid carcinoma presenting with SVC syndrome. World J Surg Oncol, 2009, 7: 75.
19.	Leo F, Della Grazia L, Tullii M, et al. Hemodynamic instability during superior vena cava crossclamping: predictors, management, and clinical consequences. J Thorac Cardiovasc Surg, 2007, 133(4): 1105-1106.
20.	Shintani Y, Ohta M, Minami M, et al. Long-term graft patency after replacement of the brachiocephalic veins combined with resection of mediastinal tumors. J Thorac Cardiovasc Surg, 2005, 129(4): 809-812.
21.	Saraya T, Shimura C, Mikura S, et al. Huge mediastinal mass with SVC syndrome accompanying numerous chest wall collateral vessels. Intern Med, 2008, 47(19): 1719-1722.
22.	Rena O, Davoli F, Allegra G, et al. Giant chordoma of the upper thoracic spine with mediastinal involvement: a surgical challenge. Asian Spine J, 2014, 8(3): 353-356.
23.	Cakmak H, Tokat AO, Karasu S, et al. Giant mediastinal parathyroid adenoma. Tuberk Toraks, 2011, 59(3): 263-265.
24.	Hayat J, Ahmed R, Alizai S, et al. Giant ganglioneuroma of the posterior mediastinum. Interact Cardiovasc Thorac Surg, 2011, 13(3): 344-345.

1. Keon TP. Death on induction of anesthesia for cervical biopsy. Anesthesiology, 1981, 55(4): 471-472.
2. Lin CM, Hsu JC. Anterior mediastinal tumour identified by intraoperative transesophageal echocardiography. Can J Anaesth, 2001, 48(1): 78-80.
3. Al-Sanouri I, Shaban M, Al-Shahid M, et al. A 21-year-old woman with mediastinal mass and cardiac arrest. BMJ Case Rep, 2013, 19: 1-4.
4. 许林, 沈振亚. 巨大纵隔肿瘤的外科治疗. 实用临床医药杂志, 2007, 11(3): 53-54.0.
5. Marchevsky AM. Mediastinal tumors of peripheral nervous system origin. Semin Diagn Pathol, 1999, 16(1): 65-78.
6. Webb WR, Gatsonis C, Zerhouni EA, et al. CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. Radiology, 1991, 178(3): 705-713.
7. Biederer J, Mirsadraee S, Beer M, et al. MRI of the lung (3/3)-current applications and future perspectives. Insights Imaging, 2012, 3(4): 373-386.
8. Rena O, Filosso PL, Papalia E, et al. Solitary fibrous tumor of the pleura: surgical treatment. Eur J Cardiothorac Surg, 2001, 19(2): 185-189.
9. Béchard P, Létourneau L, Lacasse Y, et al. Perioperative cardiorespiratory complications in adults with mediastinal mass: incidence and risk factors. Anesthesiology, 2004, 100(4): 826-834.
10. Slinger P, Karsli C. Management of the patient with a large anterior mediastinal mass: recurring myths. Curr Opin Anaesthesiol, 2007, 20(1): 1-3.
11. Cardillo G, Faccilo F, Cavazzana AO, et al. Localized (solitary) fibrous tumors of the pleura: an analysis of 55 patients. Ann Thorac Surg, 2000, 70(6): 1808-1812.
12. Kaul P, Kay S, Gaines P, et al. Giant pleural fibroma with an abdominal vascular supply mimicking a pulmonary sequestration. Ann Thorac Surg, 2003, 76(3): 935-937.
13. Chao YK, Liu YH, Hsieh MJ, et al. Controlling difficult airway by rigid bronchoscope-an old but effective method. Interact Cardiovasc Thorac Surg, 2005, 4(3): 175-179.
14. Wiseman O, Preston PG, Clarke JM. Presentation of thyroid carcinoma as a thrombosed external jugular vein, with intraluminal tumour thrombus in the great veins. Eur J Surg Oncol, 2000, 26(8): 816-817.
15. Inoue M, Minami M, Shiono H, et al. Efficient clinical application of percutaneous cardiopulmonary support for perioperative management of a huge anterior mediastinal tumor. J Thorac Cardiovasc Surg, 2006, 131(3): 755-756.
16. Anderson DM, Dimitrova GT, Awad H. Patient with posterior mediastinal mass requiring urgent cardiopulmonary bypass. Anesthesiology, 2011, 114(6): 1488-1493.
17. Li WW, van Boven WJ, Annema JT. et al. Management of large mediastinal masses: Surgical and anesthesiological considerations. J Thorac Dis, 2016, 8(3): E175-E184.
18. Wada N, Masudo K; Hirakawa S, et al. Superior vena cava (SVC) reconstruction using autologous tissue in two patients of differentiated thyroid carcinoma presenting with SVC syndrome. World J Surg Oncol, 2009, 7: 75.
19. Leo F, Della Grazia L, Tullii M, et al. Hemodynamic instability during superior vena cava crossclamping: predictors, management, and clinical consequences. J Thorac Cardiovasc Surg, 2007, 133(4): 1105-1106.
20. Shintani Y, Ohta M, Minami M, et al. Long-term graft patency after replacement of the brachiocephalic veins combined with resection of mediastinal tumors. J Thorac Cardiovasc Surg, 2005, 129(4): 809-812.
21. Saraya T, Shimura C, Mikura S, et al. Huge mediastinal mass with SVC syndrome accompanying numerous chest wall collateral vessels. Intern Med, 2008, 47(19): 1719-1722.
22. Rena O, Davoli F, Allegra G, et al. Giant chordoma of the upper thoracic spine with mediastinal involvement: a surgical challenge. Asian Spine J, 2014, 8(3): 353-356.
23. Cakmak H, Tokat AO, Karasu S, et al. Giant mediastinal parathyroid adenoma. Tuberk Toraks, 2011, 59(3): 263-265.
24. Hayat J, Ahmed R, Alizai S, et al. Giant ganglioneuroma of the posterior mediastinum. Interact Cardiovasc Thorac Surg, 2011, 13(3): 344-345.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical strategy for giant mediastinal mass

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