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ADVANCES IN SURGICAL APPROACHES TO MEDIASTINAL MASSES: A THREE-YEAR EXPERIENCE

St. Luke’s-Roosevelt Hospital Center, New York, NY

PURPOSE: Mediastinal masses can be approached through a variety of surgical techniques, including sternotomy, thoracotomy, and thoracoscopy, depending on indication, location, and extent of disease. Our experience reflects the current advances in surgical techniques for diagnosis and treatment of mediastinal masses.

METHODS: A retrospective comparative study of the surgical approaches to anterior and posterior mediastinal mass resection was performed using our thoracic surgery database for patients treated between January 2002 and December 2004. Forty patients presented with anterior pathology (25 sternotomy, 3 thoracotomy, 9 robotic thoracoscopy, and 3 video-assisted thoracoscopy (VATS)). Eleven patients had posterior pathology (3 thoracotomy, 1 sternotomy, 1 transcervical approach, and 6 VATS). Data was analyzed with Mann-Whitney U-test, Student’s T-test, and Chi-square.

RESULTS: Tissue of thymic origin (including thymoma, hyperplasia, and cysts) represented 80% (32/40) of anterior pathology. Schwannomas and neurofibromas represented 45% (5/11) and 27% (3/11), respectively, of posterior pathology. Patients who underwent minimally invasive approaches (VATS and robotic-assisted) for anterior mediastinal masses had shorter length of chest tube days and length of hospital stay (p=0.016 & p=0.002, respectively). Similarly, patients who underwent VATS for posterior mediastinal masses had shorter operative times, length of chest tube days, and length of hospital stay but no statistical significance was achieved. No significant difference in other patient demographics or immediate post-op and 30-day mortality was noted in either anterior or posterior groups.

CONCLUSION: Minimally invasive approaches offer advantages compared to traditional open resection in selected cases. A decision analysis for patients presenting with mediastinal masses needs to be made on an individual basis and is dependent upon, size of the mediastinal mass, body habitus, co-morbidities, and surgeon comfort with the approach.

CLINICAL IMPLICATIONS: Thoracic surgeons should be familiar with all surgical techniques especially thoracoscopic and robotic approaches for the management of mediastinal disease.

Anterior Mediastinal Masses Posterior Mediastinal Masses OPEN N=28 VATS/ROBOT N=12 p OPEN N=5 VATS N=6 p # Pack-years 10.5 0.92 0.101 3.0 6.7 NS OR time (min) 186 165 NS 245 205 NS Chest tube (days) 2.5 1.7 0.016 3.0 2.5 NS LOS (days) 6.1 3.4 0.002 7.0 3.8 0.157

DISCLOSURE: John Afthinos, None.