2022 Chinese expert consensus on perioperative and whole-course diagnosis and treatment of mediastinal and chest wall tumors_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

Mediastinum and Chest Wall Group of Thoracic Surgeon Branch of Chinese Medical Doctor Association , Thoracic Surgery Committee of Chinese Research Hospital Association , Lung Cancer Prevention Branch of China International Exchange and Promotive Association for Medical and Health Care , Thoracic Surgery Branch of Zhejiang Medical Association , Thoracic Surgeon Branch of Zhejiang Medical Doctors Association , Expert Group on 2022 Chinese Expert Consensus on Perioperative and Whole-course Diagnosis and Treatment of Mediastinal and Chest Wall TumorsDepartment of Thoracic Surgery

The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Clinical Evaluation Technology for Medical Device of Zhejiang Province, Hangzhou, 310003, P. R. China;

Corresponding author：

Keywords：

Chest tumor; mediastinal tumor; chest wall tumor; thoracic surgery; expert consensus

DOI：

10.7507/1007-4848.202212063

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Mediastinal and chest wall tumors contain various benign and malignant tumors. In order to further standardize the whole-course diagnosis and treatment of mediastinal and chest wall tumors, the consensus was formulated through discussion by the expert group. Based on the clinical diagnosis and treatment experience and various prospective and retrospective studies, the consensus was formed.

Citation： Mediastinum and Chest Wall Group of Thoracic Surgeon Branch of Chinese Medical Doctor Association, Thoracic Surgery Committee of Chinese Research Hospital Association, Lung Cancer Prevention Branch of China International Exchange and Promotive Association for Medical and Health Care, Thoracic Surgery Branch of Zhejiang Medical Association, Thoracic Surgeon Branch of Zhejiang Medical Doctors Association, Expert Group on 2022 Chinese Expert Consensus on Perioperative and Whole-course Diagnosis and Treatment of Mediastinal and Chest Wall TumorsDepartment of Thoracic Surgery. 2022 Chinese expert consensus on perioperative and whole-course diagnosis and treatment of mediastinal and chest wall tumors. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 325-332. doi: 10.7507/1007-4848.202212063 Copy

1.	Carter BW, Marom EM, Detterbeck FC. Approaching the patient with an anterior mediastinal mass: A guide for clinicians. J Thorac Oncol, 2014, 9(9): S102-S109.
2.	Cipriano A, Burfeind WJ. Management of primarys tissue tumors of the chest wall. Thorac Surg Clin, 2017, 27(2): 139-147.
3.	浙江省医学会胸外科学分会, 浙江省预防医学会肺癌预防与控制专业委员会, 浙江省医师协会胸外科医师分会, 等. 胸部肿瘤(一): 纵隔及胸壁(胸膜)肿瘤诊治—浙江省胸外科专家共识. 浙江医学, 2022, 44(8): 787-800, 811.
4.	LoCicero J, Feins RH, Colson YL, et al. Shields' General Thoracic Surgery, 8th Edition. M. Wolters Kluwer Health, 2018.
5.	Juanpere S, Canete N, Ortuno P, et al. A diagnostic approach to the mediastinal masses. Insights Imaging, 2013, 4(1): 29-52.
6.	Friedberg J W, Chengazi V. PET scans in the staging of lymphoma: Current status. Oncologist, 2003, 8(5): 438-447.
7.	Paes FM, Kalkanis DG, Sideras PA, et al. FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease. Radiographics, 2010, 30(1): 269-291.
8.	Colice GL, Shafazand S, Griffin JP, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 161S-177S.
9.	Gilhus NE. Myasthenia gravis. N Engl J Med, 2016, 375(26): 2570-2581.
10.	Caposole MZ, Aruca-Bustillo V, Mitchell M, et al. Benign metachronous bilateral ovarian and mediastinal teratomas with an elevated alpha-fetoprotein. Ann Thorac Surg, 2015, 99(3): 1073-1075.
11.	Yajima T, Mogi A, Shimizu K, et al. Ectopic thymoma in the paratracheal region of the middle mediastinum: A rare case report and literature review. BMC Res Notes, 2018, 11(1): 256.
12.	Thiryayi SA, Rana DN, Narine N, et al. Establishment of an endobronchial ultrasound-guided transbronchial fine needle aspiration service with rapid on-site evaluation: 2 years experience of a single UK centre. Cytopathology, 2016, 27(5): 335-343.
13.	Patel KN, Yip L, Lubitz CC, et al. The American association of endocrine surgeons guidelines for the definitive surgical management of thyroid disease in adults. Ann Surg, 2020, 271(3): e21-e93.
14.	Knobel M. An overview of retrosternal goiter. J Endocrinol Invest, 2021, 44(4): 679-691.
15.	Yoldas T, Makay O, Icoz G, et al. Should subtotal thyroidectomy be abandoned in multinodular goiter patients from endemic regions requiring surgery? Int Surg, 2015, 100(1): 9-14.
16.	Shaha AR. Substernal goiter: What is in a definition? Surg, 2010, 147(2): 239-240.
17.	Markowiak T, Hofmann HS, Ried M. Classification and staging of thymoma. J Thorac Dis, 2020, 12(12): 7607-7612.
18.	Cata JP, Lasala JD, Williams W, et al. Myasthenia gravis and thymoma surgery: A clinical update for the cardiothoracic anesthesiologist. J Cardiothorac Vasc Anesth, 2019, 33(9): 2537-2545.
19.	曾理平, 王志田, 何哲浩, 等. 达芬奇机器人与胸腔镜下纵隔肿瘤切除术的回顾性队列研究. 中国胸心血管外科临床杂志, 2020, 27(3): 279-283.
20.	Hwang Y, Park IK, Park S, et al. Lymph node dissection in thymic malignancies: implication of the ITMIG lymph node map, TNM stage classification, and recommendations. J Thorac Oncol, 2016, 11(1): 108-114.
21.	Forquer JA, Rong N, Fakiris AJ, et al. Postoperative radiotherapy after surgical resection of thymoma: Differing roles in localized and regional disease. Int J Radiat Oncol Biol Phys, 2010, 76(2): 440-445.
22.	Gomez D, Komaki R, Yu J, et al. Radiation therapy definitions and reporting guidelines for thymic malignancies. J Thorac Oncol, 2011, 6(7 Suppl 3): S1743-S1748.
23.	Schmitt J, Loehrer PS. The role of chemotherapy in advanced thymoma. J Thorac Oncol, 2010, 5(10 Suppl 4): S357-S360.
24.	Giaccone G, Kim C, Thompson J, et al. Pembrolizumab in patients with thymic carcinoma: A single-arm, single-centre, phase 2 study. Lancet Oncol, 2018, 19(3): 347-355.
25.	Girard N. Chemotherapy and targeted agents for thymic malignancies. Expert Rev Anticancer Ther, 2012, 12(5): 685-695.
26.	Pham LH, Trinh DK, Nguyen AV, et al. Thoracoscopic surgery approach to mediastinal mature teratomas: A single-center experience. J Cardiothorac Surg, 2020, 15(1): 35.
27.	Gossot D, Izquierdo RR, Girard P, et al. Thoracoscopic resection of bulky intrathoracic benign lesions. Eur J Cardiothorac Surg, 2007, 32(6): 848-851.
28.	Johnson PW. Ⅳ. Masses in the mediastinum: Primary mediastinal lymphoma and intermediate types. Hematol Oncol, 2015, 33 Suppl 1: 29-32.
29.	Yu Y, Dong X, Tu M, et al. Primary mediastinal large B cell lymphoma. Thorac Cancer, 2021, 12(21): 2831-2837.
30.	Kocaturk CI, Sezen CB, Aker C, et al. Surgical approach to posterior mediastinal lesions and long-term outcomes. Asian Cardiovasc Thorac Ann, 2017, 25(4): 287-291.
31.	Che WC, Zang Q, Zhu Q, et al. Lipoma-like bronchogenic cyst in the right chest sidewall: A case report and literature review. Ann Thorac Cardiovasc Surg, 2016, 22(6): 370-374.
32.	Lee DH, Park CK, Kum DY, et al. Clinical characteristics and management of intrathoracic bronchogenic cysts: A single center experience. Korean J Thorac Cardiovasc Surg, 2011, 44(4): 279-284.
33.	Kar SK, Ganguly T. Current concepts of diagnosis and management of pericardial cysts. Indian Heart J, 2017, 69(3): 364-370.
34.	Altieri MS, Zheng R, Pryor AD, et al. Esophageal bronchogenic cyst and review of the literature. Surg Endosc, 2015, 29(10): 3010-3015.
35.	Kang CU, Cho DG, Cho KD, et al. Thoracoscopic stapled resection of multiple esophageal duplication cysts with different pathological findings. Eur J Cardiothorac Surg, 2008, 34(1): 216-218.
36.	Yang X, Zong Y, Zhao HY, et al. Complete excision of esophageal bronchogenic cyst by endoscopic submucosal tunnel dissection: A case presentation. BMC Gastroenterol, 2019, 19(1): 155.
37.	Watanobe I, Ito Y, Akimoto E, et al. Laparoscopic resection of an intra-abdominal esophageal duplication cyst: A case report and literature review. Case Rep Surg, 2015, 2015: 940768.
38.	Carter BW, Benveniste MF, Betancourt SL, et al. Imaging evaluation of malignant chest wall neoplasms. Radiographics, 2016, 36(5): 1285-1306.
39.	Bueno J, Lichtenberger JR, Rauch G, et al. MR imaging of primary chest wall neoplasms. Top Magn Reson Imaging, 2018, 27(2): 83-93.
40.	Thomas M, Shen KR. Primary tumors of the osseous chest wall and their management. Thorac Surg Clin, 2017, 27(2): 181-193.
41.	Welker JA, Henshaw RM, Jelinek J, et al. The percutaneous needle biopsy is safe and recommended in the diagnosis of musculoskeletal masses. Cancer, 2000, 89(12): 2677-2686.
42.	Aydogdu K, Findik G, Agackiran Y, et al. Primary tumors of the ribs; experience with 78 patients. Interact Cardiovasc Thorac Surg, 2009, 9(2): 251-254.
43.	Shah AA, D'Amico TA. Primary chest wall tumors. J Am Coll Surg, 2010, 210(3): 360-366.
44.	Smith SE, Keshavjee S. Primary chest wall tumors. Thorac Surg Clin, 2010, 20(4): 495-507.
45.	Hughes EK, James SL, Butt S, et al. Benign primary tumours of the ribs. Clin Radiol, 2006, 61(4): 314-322.
46.	Bielack SS, Carrle D, Hardes J, et al. Bone tumors in adolescents and young adults. Curr Treat Options Oncol, 2008, 9(1): 67-80.
47.	Peng L, Deng HY, Yang Y, et al. Askin tumor in the chest wall. Thorac Cancer, 2021, 12(3): 407-408.
48.	Wu JM, Montgomery E. Classification and pathology. Surg Clin North Am, 2008, 88(3): 483-520.
49.	Ahmad U, Yang H, Sima C, et al. Resection of primary and secondary tumors of the sternum: An analysis of prognostic variables. Ann Thorac Surg, 2015, 100(1): 215-222.
50.	Parratt MT, Donaldson JR, Flanagan AM, et al. Elastofibroma dorsi: Management, outcome and review of the literature. J Bone Joint Surg Br, 2010, 92(2): 262-266.
51.	Bolke E, Krasniqi H, Lammering G, et al. Chest wall and intrathoracic desmoid tumors: Surgical experience and review of the literature. Eur J Med Res, 2009, 14(6): 240-243.
52.	Yoshida N, Miyanari N, Yamamoto Y, et al. Successful treatment of malignant fibrous histiocytoma originating in the chest wall: Report of a case. Surg Today, 2006, 36(8): 714-721.
53.	Hung JJ, Chou TY, Sun CH, et al. Primary synovial sarcoma of the posterior chest wall. Ann Thorac Surg, 2008, 85(6): 2120-2122.
54.	Gross JL, Younes RN, Haddad FJ, et al. Soft-tissue sarcomas of the chest wall: Prognostic factors. Chest, 2005, 127(3): 902-908.
55.	des Guetz G, Chapelier A, Mosseri V, et al. Postirradiation sarcoma: Clinicopathologic features and role of chemotherapy in the treatment strategy. Sarcoma, 2009, 2009: 764379.
56.	Anderson BO, Burt ME. Chest wall neoplasms and their management. Ann Thorac Surg, 1994, 58(6): 1774-1781.
57.	Gonfiotti A, Salvicchi A, Voltolini L. Chest-wall tumors and surgical techniques: State-of-the-art and our institutional experience. J Clin Med, 2022, 11(19): 5516.

1. Carter BW, Marom EM, Detterbeck FC. Approaching the patient with an anterior mediastinal mass: A guide for clinicians. J Thorac Oncol, 2014, 9(9): S102-S109.
2. Cipriano A, Burfeind WJ. Management of primarys tissue tumors of the chest wall. Thorac Surg Clin, 2017, 27(2): 139-147.
3. 浙江省医学会胸外科学分会, 浙江省预防医学会肺癌预防与控制专业委员会, 浙江省医师协会胸外科医师分会, 等. 胸部肿瘤(一): 纵隔及胸壁(胸膜)肿瘤诊治—浙江省胸外科专家共识. 浙江医学, 2022, 44(8): 787-800, 811.
4. LoCicero J, Feins RH, Colson YL, et al. Shields' General Thoracic Surgery, 8th Edition. M. Wolters Kluwer Health, 2018.
5. Juanpere S, Canete N, Ortuno P, et al. A diagnostic approach to the mediastinal masses. Insights Imaging, 2013, 4(1): 29-52.
6. Friedberg J W, Chengazi V. PET scans in the staging of lymphoma: Current status. Oncologist, 2003, 8(5): 438-447.
7. Paes FM, Kalkanis DG, Sideras PA, et al. FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease. Radiographics, 2010, 30(1): 269-291.
8. Colice GL, Shafazand S, Griffin JP, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest, 2007, 132(3 Suppl): 161S-177S.
9. Gilhus NE. Myasthenia gravis. N Engl J Med, 2016, 375(26): 2570-2581.
10. Caposole MZ, Aruca-Bustillo V, Mitchell M, et al. Benign metachronous bilateral ovarian and mediastinal teratomas with an elevated alpha-fetoprotein. Ann Thorac Surg, 2015, 99(3): 1073-1075.
11. Yajima T, Mogi A, Shimizu K, et al. Ectopic thymoma in the paratracheal region of the middle mediastinum: A rare case report and literature review. BMC Res Notes, 2018, 11(1): 256.
12. Thiryayi SA, Rana DN, Narine N, et al. Establishment of an endobronchial ultrasound-guided transbronchial fine needle aspiration service with rapid on-site evaluation: 2 years experience of a single UK centre. Cytopathology, 2016, 27(5): 335-343.
13. Patel KN, Yip L, Lubitz CC, et al. The American association of endocrine surgeons guidelines for the definitive surgical management of thyroid disease in adults. Ann Surg, 2020, 271(3): e21-e93.
14. Knobel M. An overview of retrosternal goiter. J Endocrinol Invest, 2021, 44(4): 679-691.
15. Yoldas T, Makay O, Icoz G, et al. Should subtotal thyroidectomy be abandoned in multinodular goiter patients from endemic regions requiring surgery? Int Surg, 2015, 100(1): 9-14.
16. Shaha AR. Substernal goiter: What is in a definition? Surg, 2010, 147(2): 239-240.
17. Markowiak T, Hofmann HS, Ried M. Classification and staging of thymoma. J Thorac Dis, 2020, 12(12): 7607-7612.
18. Cata JP, Lasala JD, Williams W, et al. Myasthenia gravis and thymoma surgery: A clinical update for the cardiothoracic anesthesiologist. J Cardiothorac Vasc Anesth, 2019, 33(9): 2537-2545.
19. 曾理平, 王志田, 何哲浩, 等. 达芬奇机器人与胸腔镜下纵隔肿瘤切除术的回顾性队列研究. 中国胸心血管外科临床杂志, 2020, 27(3): 279-283.
20. Hwang Y, Park IK, Park S, et al. Lymph node dissection in thymic malignancies: implication of the ITMIG lymph node map, TNM stage classification, and recommendations. J Thorac Oncol, 2016, 11(1): 108-114.
21. Forquer JA, Rong N, Fakiris AJ, et al. Postoperative radiotherapy after surgical resection of thymoma: Differing roles in localized and regional disease. Int J Radiat Oncol Biol Phys, 2010, 76(2): 440-445.
22. Gomez D, Komaki R, Yu J, et al. Radiation therapy definitions and reporting guidelines for thymic malignancies. J Thorac Oncol, 2011, 6(7 Suppl 3): S1743-S1748.
23. Schmitt J, Loehrer PS. The role of chemotherapy in advanced thymoma. J Thorac Oncol, 2010, 5(10 Suppl 4): S357-S360.
24. Giaccone G, Kim C, Thompson J, et al. Pembrolizumab in patients with thymic carcinoma: A single-arm, single-centre, phase 2 study. Lancet Oncol, 2018, 19(3): 347-355.
25. Girard N. Chemotherapy and targeted agents for thymic malignancies. Expert Rev Anticancer Ther, 2012, 12(5): 685-695.
26. Pham LH, Trinh DK, Nguyen AV, et al. Thoracoscopic surgery approach to mediastinal mature teratomas: A single-center experience. J Cardiothorac Surg, 2020, 15(1): 35.
27. Gossot D, Izquierdo RR, Girard P, et al. Thoracoscopic resection of bulky intrathoracic benign lesions. Eur J Cardiothorac Surg, 2007, 32(6): 848-851.
28. Johnson PW. Ⅳ. Masses in the mediastinum: Primary mediastinal lymphoma and intermediate types. Hematol Oncol, 2015, 33 Suppl 1: 29-32.
29. Yu Y, Dong X, Tu M, et al. Primary mediastinal large B cell lymphoma. Thorac Cancer, 2021, 12(21): 2831-2837.
30. Kocaturk CI, Sezen CB, Aker C, et al. Surgical approach to posterior mediastinal lesions and long-term outcomes. Asian Cardiovasc Thorac Ann, 2017, 25(4): 287-291.
31. Che WC, Zang Q, Zhu Q, et al. Lipoma-like bronchogenic cyst in the right chest sidewall: A case report and literature review. Ann Thorac Cardiovasc Surg, 2016, 22(6): 370-374.
32. Lee DH, Park CK, Kum DY, et al. Clinical characteristics and management of intrathoracic bronchogenic cysts: A single center experience. Korean J Thorac Cardiovasc Surg, 2011, 44(4): 279-284.
33. Kar SK, Ganguly T. Current concepts of diagnosis and management of pericardial cysts. Indian Heart J, 2017, 69(3): 364-370.
34. Altieri MS, Zheng R, Pryor AD, et al. Esophageal bronchogenic cyst and review of the literature. Surg Endosc, 2015, 29(10): 3010-3015.
35. Kang CU, Cho DG, Cho KD, et al. Thoracoscopic stapled resection of multiple esophageal duplication cysts with different pathological findings. Eur J Cardiothorac Surg, 2008, 34(1): 216-218.
36. Yang X, Zong Y, Zhao HY, et al. Complete excision of esophageal bronchogenic cyst by endoscopic submucosal tunnel dissection: A case presentation. BMC Gastroenterol, 2019, 19(1): 155.
37. Watanobe I, Ito Y, Akimoto E, et al. Laparoscopic resection of an intra-abdominal esophageal duplication cyst: A case report and literature review. Case Rep Surg, 2015, 2015: 940768.
38. Carter BW, Benveniste MF, Betancourt SL, et al. Imaging evaluation of malignant chest wall neoplasms. Radiographics, 2016, 36(5): 1285-1306.
39. Bueno J, Lichtenberger JR, Rauch G, et al. MR imaging of primary chest wall neoplasms. Top Magn Reson Imaging, 2018, 27(2): 83-93.
40. Thomas M, Shen KR. Primary tumors of the osseous chest wall and their management. Thorac Surg Clin, 2017, 27(2): 181-193.
41. Welker JA, Henshaw RM, Jelinek J, et al. The percutaneous needle biopsy is safe and recommended in the diagnosis of musculoskeletal masses. Cancer, 2000, 89(12): 2677-2686.
42. Aydogdu K, Findik G, Agackiran Y, et al. Primary tumors of the ribs; experience with 78 patients. Interact Cardiovasc Thorac Surg, 2009, 9(2): 251-254.
43. Shah AA, D'Amico TA. Primary chest wall tumors. J Am Coll Surg, 2010, 210(3): 360-366.
44. Smith SE, Keshavjee S. Primary chest wall tumors. Thorac Surg Clin, 2010, 20(4): 495-507.
45. Hughes EK, James SL, Butt S, et al. Benign primary tumours of the ribs. Clin Radiol, 2006, 61(4): 314-322.
46. Bielack SS, Carrle D, Hardes J, et al. Bone tumors in adolescents and young adults. Curr Treat Options Oncol, 2008, 9(1): 67-80.
47. Peng L, Deng HY, Yang Y, et al. Askin tumor in the chest wall. Thorac Cancer, 2021, 12(3): 407-408.
48. Wu JM, Montgomery E. Classification and pathology. Surg Clin North Am, 2008, 88(3): 483-520.
49. Ahmad U, Yang H, Sima C, et al. Resection of primary and secondary tumors of the sternum: An analysis of prognostic variables. Ann Thorac Surg, 2015, 100(1): 215-222.
50. Parratt MT, Donaldson JR, Flanagan AM, et al. Elastofibroma dorsi: Management, outcome and review of the literature. J Bone Joint Surg Br, 2010, 92(2): 262-266.
51. Bolke E, Krasniqi H, Lammering G, et al. Chest wall and intrathoracic desmoid tumors: Surgical experience and review of the literature. Eur J Med Res, 2009, 14(6): 240-243.
52. Yoshida N, Miyanari N, Yamamoto Y, et al. Successful treatment of malignant fibrous histiocytoma originating in the chest wall: Report of a case. Surg Today, 2006, 36(8): 714-721.
53. Hung JJ, Chou TY, Sun CH, et al. Primary synovial sarcoma of the posterior chest wall. Ann Thorac Surg, 2008, 85(6): 2120-2122.
54. Gross JL, Younes RN, Haddad FJ, et al. Soft-tissue sarcomas of the chest wall: Prognostic factors. Chest, 2005, 127(3): 902-908.
55. des Guetz G, Chapelier A, Mosseri V, et al. Postirradiation sarcoma: Clinicopathologic features and role of chemotherapy in the treatment strategy. Sarcoma, 2009, 2009: 764379.
56. Anderson BO, Burt ME. Chest wall neoplasms and their management. Ann Thorac Surg, 1994, 58(6): 1774-1781.
57. Gonfiotti A, Salvicchi A, Voltolini L. Chest-wall tumors and surgical techniques: State-of-the-art and our institutional experience. J Clin Med, 2022, 11(19): 5516.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

2022 Chinese expert consensus on perioperative and whole-course diagnosis and treatment of mediastinal and chest wall tumors

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