Surgical Management of Mediastial Tumor Invading the Heart or Great Vessels_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIELiang ,  CHENGang , DENGCheng , TANGJi-ming , XIAOPu , ZHOUHai-yu , BENXiao-song , ZHOUZi-hao , YEXiong , ZHANGDong-kun

Department of Thoracic Surgery, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, P. R. China;

Corresponding author：

CHENGang, Email: chenganggz@126.com

Keywords：

Mediastinal tumor; Surgical treatment; Heart or great vessels

DOI：

10.7507/1007-4848.20160010

Video：

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Objective To summarize the surgical management of complicated mediastinal tumor involving the heart or great vessels. Methods We retrospectively analyzed the clinical data of 38 patients with complicated mediastinal tumor invading the heart and large blood vessels underwent extended thymectomy in our hospital between February 1997 and May 2014. There were 26 males and 12 females at age of 41.3± 13.6 years ranking from 4 to 68 years. Multiple personalized procedures were applied within the 38 patients and some patients underwent more than one procedure. Besides the resection of mediastinal tumor, 3 patients underwent partial right atrial resection. Sixteen patients underwent resection, plasty or grafting vessels. Ten patients took partial excision and repair of pericardium. Eight patients underwent pulmonary wedge resection. Two patients underwent lobectomy. Two patients required cardiopulmonary bypass. Result All operations were completed successfully. There was no perioperative mortality. The operating time was 105-282 min and blood loss was 200-1 500 ml. The postoperative complications rate was 23.7%. The incidence of ICU admission was 47.4% with an average ICU stay of 1.8 days. The average length of post-operative hospital stay was 11.2 days. The five-year survival rate was 57.0%. Conclusion Surgical resection of mediastinal tumor invading the heart or great vessels is complicated and highly risky. However, desirable clinical outcome can be achieved with comprehensive perioperative assessment and appropriate surgical procedures.

Citation： XIELiang, CHENGang, DENGCheng, TANGJi-ming, XIAOPu, ZHOUHai-yu, BENXiao-song, ZHOUZi-hao, YEXiong, ZHANGDong-kun. Surgical Management of Mediastial Tumor Invading the Heart or Great Vessels. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(1): 38-43. doi: 10.7507/1007-4848.20160010 Copy

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5.	杨永波, 尤嘉琮, 周清华.胸部肿瘤引起的上腔静脉综合征的外科治疗.中国肺癌杂志, 2009, 12(9): 1018-1021.
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8.	Burt M, Ihde JK, Hajdu SI, et al. Primary sarcomas of the mediastinum: results of therapy. J Thorac Cardiovasc Surg, 1998, 115(3): 671-680.
9.	Garcia A, Flores RM. Surgical management of tumors invading the superior vena cava. Ann Thorac Surg, 2008, 85(6): 2144-2146.
10.	Ried M, Neu R, Schalke B, et al. Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg, 2015, 10: 137.
11.	D'Andrilli A, Venuta F, Rendina EA. Surgical approaches for invasive tumors of the anterior mediastinum. Thorac Surg Clin, 2010, 20(2): 265-284.
12.	梁恒星, 刘文亮, 王翔, 等.恶性胸腺瘤侵犯大血管的手术治疗及术后生存调查.中国现代手术学杂志, 2013, 17(2): 142-147.
13.	Ried M, Potzger T, Sziklavari Z, et al. Extended surgical resections of advanced thymoma masaoka stagesⅲand via facilitate outcome. Thorac Cardiovasc Surg, 2014, 62(2): 161-168.
14.	Gross JL, Rosalino UA, Younes RN, et al. Characteristics associated with complete surgical resection of primary malignant mediastinal tumors. J Bras Pneumol, 2009, 35(9): 832-838.
15.	Kim D, Kim SW, Hong JM. Rapid growing huge teratoma: complete surgical resection. J Thorac Dis, 2014, 6(10): E217-E219.
16.	Rusch VW. Extrapleural pneumonectomy and extended pleurectomy/decortication for malignant pleural mesothelioma: the memorial sloan-kettering cancer center approach. Ann Cardiothorac Surg, 2012, 1(4): 523-531.
17.	Kawamukai K, Antonacci F, Di Saverio S, et al. Acute postoperative cardiac herniation. Interact Cardiovasc Thorac Surg, 2011, 12(1): 73-74.
18.	王茜, 龙村.顺行性脑灌注与逆行性脑灌注.中国体外循环杂志, 20119(1): 48-52.
19.	Yoshioka M, Ichiguchi O, Hirayama T, et al. Radical excision of thymic adenocarcinoma with selective cerebral perfusion. Ann Thorac Surg, 2008, 85(4): 1427-1429.
20.	胡英斌, 胡野荣, 李津, 等.血管重建在原发性纵隔肿瘤中的临床应用.中国现代手术学杂志, 200913(5): 351-353.

1. Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest, 2005, 128(4): 2893-2909.
2. 王振捷, 于洪泉, 任华, 等.上腔静脉和无名静脉的切除及重建治疗纵隔肿瘤.中国胸心血管外科临床杂志, 2005, 12(1): 22-25.
3. Park BJ, Bacchetta M, Bains MS, et al. Surgical management of thoracic malignancies invading the heart or great vessels. Ann Thorac Surg, 2004, 78(3): 1024-1030.
4. Motus IY, Bazhenov AV, Massard G. Surgery for huge mediastinal tumors. Asi Cardiovasc Thorac Ann, 2015, 23(7): 846-850.
5. 杨永波, 尤嘉琮, 周清华.胸部肿瘤引起的上腔静脉综合征的外科治疗.中国肺癌杂志, 2009, 12(9): 1018-1021.
6. 刘玉金, 张孝军, 宋鹏, 等.纵隔肿瘤血管造影及栓塞的临床应用.介入放射学杂志, 2012, 21(11): 916-920.
7. Falkson CB, Bezjak A, Darling G, et al. The management of thymoma: a systematic review and practice guideline. J Thorac Oncol, 2009, 4(7): 911-919.
8. Burt M, Ihde JK, Hajdu SI, et al. Primary sarcomas of the mediastinum: results of therapy. J Thorac Cardiovasc Surg, 1998, 115(3): 671-680.
9. Garcia A, Flores RM. Surgical management of tumors invading the superior vena cava. Ann Thorac Surg, 2008, 85(6): 2144-2146.
10. Ried M, Neu R, Schalke B, et al. Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg, 2015, 10: 137.
11. D'Andrilli A, Venuta F, Rendina EA. Surgical approaches for invasive tumors of the anterior mediastinum. Thorac Surg Clin, 2010, 20(2): 265-284.
12. 梁恒星, 刘文亮, 王翔, 等.恶性胸腺瘤侵犯大血管的手术治疗及术后生存调查.中国现代手术学杂志, 2013, 17(2): 142-147.
13. Ried M, Potzger T, Sziklavari Z, et al. Extended surgical resections of advanced thymoma masaoka stagesⅲand via facilitate outcome. Thorac Cardiovasc Surg, 2014, 62(2): 161-168.
14. Gross JL, Rosalino UA, Younes RN, et al. Characteristics associated with complete surgical resection of primary malignant mediastinal tumors. J Bras Pneumol, 2009, 35(9): 832-838.
15. Kim D, Kim SW, Hong JM. Rapid growing huge teratoma: complete surgical resection. J Thorac Dis, 2014, 6(10): E217-E219.
16. Rusch VW. Extrapleural pneumonectomy and extended pleurectomy/decortication for malignant pleural mesothelioma: the memorial sloan-kettering cancer center approach. Ann Cardiothorac Surg, 2012, 1(4): 523-531.
17. Kawamukai K, Antonacci F, Di Saverio S, et al. Acute postoperative cardiac herniation. Interact Cardiovasc Thorac Surg, 2011, 12(1): 73-74.
18. 王茜, 龙村.顺行性脑灌注与逆行性脑灌注.中国体外循环杂志, 20119(1): 48-52.
19. Yoshioka M, Ichiguchi O, Hirayama T, et al. Radical excision of thymic adenocarcinoma with selective cerebral perfusion. Ann Thorac Surg, 2008, 85(4): 1427-1429.
20. 胡英斌, 胡野荣, 李津, 等.血管重建在原发性纵隔肿瘤中的临床应用.中国现代手术学杂志, 200913(5): 351-353.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Management of Mediastial Tumor Invading the Heart or Great Vessels

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