The diagnosis and video-assisted thoracic surgery for mediastinal bronchogenic cysts_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xun , CHEN Kezhong , LI Yun , LIU Jun ,  WANG Jun

Department of Thoracic Surgery, People’s Hospital, Peking University, Beijing, 100044, P.R.China;

Corresponding author：

WANG Jun, Email: xiongwai@263.net

Keywords：

Bronchogenic cyst; mediastinal cyst; video-assisted thoracoscopic surgery

DOI：

10.7507/1007-4848.201811026

Video：

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Objective To emphasize the important role of video-assisted thoracoscopic surgery (VATS) in treatment of mediastinal bronchogenic cysts (MBCs).Methods We retrospectively reviewed the clinical data of 112 patients (53 males and 59 females) of mediastinal bronchogenic cysts who underwent VATS in our institution between April 2001 and Aprial 2016. Median age was 4–75 (45.6±15.0) years. All patients underwent chest CT preoperatively. The patients were divided into two groups: an anterior mediastinum group, 47 patients; a middle and posterior mediastinum group, 65 patients including 35 patients in the middle mediastinum, 30 patients in the posterior mediastinum. The average diameter was 0.5–22.0 (3.50±2.33) cm. The average CT attenuation was 0–67 (35.5±15.3) Hu on unenhanced CT. We began each operation with the VATS technique.Results The CT diagnostic accuracy for group middle and posterior mediastinum with CT value≤20 Hu was higher than others (61.5% vs. 13.1%, χ²=17.675, P<0.001). A total of 111 patients underwent VATS, only one patient converted to open thoracotomy. Cyst resection and thymectomy were conducted in 45 patients, cyst resection and extended thymectomy were conducted in 2 patients in the anterior mediastinum group. Simply cyst resection were performed in the middle and posterior mediastinum group (n=65). The average operative time was 40–360 (104.5±43.1) min. The average intraoperative blood loss was 5–600 (57.9±88.9) mL. The intraoperative complication rate was 3.6% and the incomplete resection rate was 6.3%. The main reason for these was severe adhesion between the cyst and mediastinal structure. No serious postoperative complication was found. Follow-up was done in 99 patients, and the mean follow-up time was 42 (12–191) months. There was no local recurrence.Conclusion VATS resection of MBCs is a safe and efficacious procedure, and minimally invasive and surgical resection should be performed as early as possible for MBCs.

Citation： WANG Xun, CHEN Kezhong, LI Yun, LIU Jun, WANG Jun. The diagnosis and video-assisted thoracic surgery for mediastinal bronchogenic cysts. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(9): 848-852. doi: 10.7507/1007-4848.201811026 Copy

1.	Maurin S, Hery G, Bourliere B, et al. Bronchogenic cyst: clinical course from antenatal diagnosis to postnatal thoracoscopic resection. J Minim Access Surg, 2013, 9(1): 25-28.
2.	Jung HS, Kim DK, Lee GD, et al. Video-assisted thoracic surgery for bronchogenic cysts: is this the surgical approach of choice. Interact Cardiovasc Thorac Surg, 2014, 19(5): 824-829.
3.	Kozu Y, Suzuki K, Oh S, et al. Single institutional experience with primary mediastinal cysts: clinicopathological study of 108 resected patients. Ann Thorac Cardiovasc Surg, 2014, 20(5): 365-369.
4.	De Giacomo T, Diso D, Anile M, et al. Thoracoscopic resection of mediastinal bronchogenic cysts in adults. Eur J Cardiothorac Surg, 2009, 36(2): 357-359.
5.	Weber T, Roth TC, Beshay M, et al. Video-assisted thoracoscopic surgery of mediastinal bronchogenic cysts in adults: a single-center experience. Ann Thorac Surg, 2004, 78(3): 987-991.
6.	St-Georges R, Deslauriers J, Duranceau A, et al. Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult. Ann Thorac Surg, 1991, 52(1): 6-13.
7.	Mcadams HP, Kirejczyk WM, Rosado-De-Christenson ML, et al. Bronchogenic cyst: imaging features with clinical and histopathologic correlation. Radiology, 2000, 217(2): 441-446.
8.	Limaiem F, Ayadi-Kaddour AH, Kilani T, et al. Pulmonary and mediastinal bronchogenic cysts: a clinicopathologic study of 33 patients. Lung, 2008, 186(1): 55-61.
9.	王迅, 夏奥, 李晓, 等. 胸腺囊肿的诊断及全胸腔镜手术治疗: 附 72 例报告. 中国微创外科杂志, 2017, 17(5): 407-410.
10.	Guo C, Mei J, Liu C, et al. Video-assisted thoracic surgery compared with posterolateral thoracotomy for mediastinal bronchogenic cysts in adult patients. J Thorac Dis, 2016, 8(9): 2504-2511.
11.	Ueda K, Yanagawa M, Ueguchi T, et al. Paradoxical signal pattern of mediastinal cysts on T2-weighted MR imaging: phantom and clinical study. Eur J Radiol, 2014, 83(6): 1016-1021.
12.	Kirmani B, Kirmani B, Sogliani F. Should asymptomatic bronchogenic cysts in adults be treated conservatively or with surgery? Interact Cardiovasc Thorac Surg, 2010, 11(5): 649-659.
13.	Fievet L, D'Journo XB, Guys JM, et al. Bronchogenic cyst: best time for surgery? Ann Thorac Surg, 2012, 94(5): 1695-1699.
14.	Lewis RJ, Caccavale RJ, Sisler GE, et al. Imaged thoracoscopic surgery: A new thoracic technique for resection of mediastinal cysts. Ann Thorac Surg, 1992, 53(2): 318-320.
15.	Tölg C, Abelin K, Laudenbach V, et al. Open vs thoracoscopic surgical management of bronchogenic cysts. Surg Endosc, 2005, 19(1): 77-80.
16.	Read CA, Moront M, Carangelo R, et al. Recurrent bronchogenic cyst. An argument for complete surgical excision. Arch Surg, 1991, 126(10): 1306-1308.

1. Maurin S, Hery G, Bourliere B, et al. Bronchogenic cyst: clinical course from antenatal diagnosis to postnatal thoracoscopic resection. J Minim Access Surg, 2013, 9(1): 25-28.
2. Jung HS, Kim DK, Lee GD, et al. Video-assisted thoracic surgery for bronchogenic cysts: is this the surgical approach of choice. Interact Cardiovasc Thorac Surg, 2014, 19(5): 824-829.
3. Kozu Y, Suzuki K, Oh S, et al. Single institutional experience with primary mediastinal cysts: clinicopathological study of 108 resected patients. Ann Thorac Cardiovasc Surg, 2014, 20(5): 365-369.
4. De Giacomo T, Diso D, Anile M, et al. Thoracoscopic resection of mediastinal bronchogenic cysts in adults. Eur J Cardiothorac Surg, 2009, 36(2): 357-359.
5. Weber T, Roth TC, Beshay M, et al. Video-assisted thoracoscopic surgery of mediastinal bronchogenic cysts in adults: a single-center experience. Ann Thorac Surg, 2004, 78(3): 987-991.
6. St-Georges R, Deslauriers J, Duranceau A, et al. Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult. Ann Thorac Surg, 1991, 52(1): 6-13.
7. Mcadams HP, Kirejczyk WM, Rosado-De-Christenson ML, et al. Bronchogenic cyst: imaging features with clinical and histopathologic correlation. Radiology, 2000, 217(2): 441-446.
8. Limaiem F, Ayadi-Kaddour AH, Kilani T, et al. Pulmonary and mediastinal bronchogenic cysts: a clinicopathologic study of 33 patients. Lung, 2008, 186(1): 55-61.
9. 王迅, 夏奥, 李晓, 等. 胸腺囊肿的诊断及全胸腔镜手术治疗: 附 72 例报告. 中国微创外科杂志, 2017, 17(5): 407-410.
10. Guo C, Mei J, Liu C, et al. Video-assisted thoracic surgery compared with posterolateral thoracotomy for mediastinal bronchogenic cysts in adult patients. J Thorac Dis, 2016, 8(9): 2504-2511.
11. Ueda K, Yanagawa M, Ueguchi T, et al. Paradoxical signal pattern of mediastinal cysts on T2-weighted MR imaging: phantom and clinical study. Eur J Radiol, 2014, 83(6): 1016-1021.
12. Kirmani B, Kirmani B, Sogliani F. Should asymptomatic bronchogenic cysts in adults be treated conservatively or with surgery? Interact Cardiovasc Thorac Surg, 2010, 11(5): 649-659.
13. Fievet L, D'Journo XB, Guys JM, et al. Bronchogenic cyst: best time for surgery? Ann Thorac Surg, 2012, 94(5): 1695-1699.
14. Lewis RJ, Caccavale RJ, Sisler GE, et al. Imaged thoracoscopic surgery: A new thoracic technique for resection of mediastinal cysts. Ann Thorac Surg, 1992, 53(2): 318-320.
15. Tölg C, Abelin K, Laudenbach V, et al. Open vs thoracoscopic surgical management of bronchogenic cysts. Surg Endosc, 2005, 19(1): 77-80.
16. Read CA, Moront M, Carangelo R, et al. Recurrent bronchogenic cyst. An argument for complete surgical excision. Arch Surg, 1991, 126(10): 1306-1308.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The diagnosis and video-assisted thoracic surgery for mediastinal bronchogenic cysts

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