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Erschienen in:
22.12.2015
Clinical results of surgical resection of mediastinal teratoma: efficacy of video-assisted thoracic surgery
Erschienen in: Surgical Endoscopy | Ausgabe 9/2016
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Background
In patients with a mediastinal tumor, video-assisted thoracic surgery (VATS) is considered to be associated with more postoperative advantages compared to open procedures. However, open procedures are still preferred in cases with large or malignant tumors. Therefore, in order to determine the appropriate surgical strategies for resection of teratomas, we here review our experience with such cases.
Methods
Between January 2000 and February 2014, we experienced 132 patients diagnosed with mediastinal teratoma. By using data from a retrospective review of the patients’ medical records, we compared the demographic characteristics, hospital stay duration, chest tube indwelling time, operative time, and mass size of the VATS group with those of the patients in the open group. Moreover, we also analyzed the postoperative complications and recurrence. Finally, based on our findings, we created a ‘∆V (volume of the mass—volume of the cyst in the mass)’ capable of determining the appropriate surgical strategy, measured by preoperative computed tomography scan.
Results
We excised the mass using VATS in 79 patients, while 53 patients underwent open procedures, including thoracotomy (n = 10) and median sternotomy (n = 43). The operative times, the hospital stay duration, and the chest tube indwelling time were significantly shorter in the VATS group compared to in the open group (Table 1). Four cases were converted to thoracotomy. The mean mass sizes were 6.53 ± 2.20 cm and 8.58 ± 3.45 cm in the VATS and open groups, respectively. The ‘∆V’ of the VATS group was higher than that of the open group. There were three postoperative complications.
Table 1
Comparison of the perioperative variables between the VATS group and open groups
VATS (n = 79) | Open (n = 53) |
p value | |
|---|---|---|---|
Preoperative variables
| |||
Age (years) | 32.34 ± 13.44 | 29.30 ± 14.76 | 0.223 |
Female | 63 | 28 | 0.001 |
BMI | 22.07 ± 3.34 | 22.59 ± 3.91 | 0.409 |
ASA class | 0.272 | ||
Class 1 | 39 | 21 | |
Class 2 | 40 | 32 | |
Mass size (cm) | 6.53 ± 2.20 | 8.58 ± 3.45 | <0.001 |
∆V (cm3) | 988.15 ± 1590.85 | 3093.22 ± 4947.33 | 0.001 |
Intraoperative variable
| |||
Operative time (min) | 129 ± 46 | 170 ± 45 | <0.001 |
Postoperative variable
| |||
Hospitalization (days) | 6.00 ± 3.03 | 8.94 ± 3.99 | <0.001 |
ICU stay (days) | 0 | 0.42 ± 0.50 | <0.001 |
CTD time (days) | 2.00 ± 1.24 | 3.8 ± 3.63 | <0.001 |
Median F/U duration (months) | 47.16 ± 43.60 | 27.52 ± 34.00 | |
Conclusion
VATS for mediastinal teratoma can be performed safely in selected patients with large or malignant masses. The proposed ‘∆V’ appears to be a useful method for determining the appropriate surgical strategy in the large size teratoma cases.