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Cao M, Wang Q, Yin H, Fu Y, Zhao X. Short-term analysis of uniport video-assisted thoracoscopic surgery via the subxiphoid approach without chest tube drainage for anterior mediastinal tumors: a comparative retrospective study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1687. [PMID: 34988196 PMCID: PMC8667127 DOI: 10.21037/atm-21-5790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022]
Abstract
Background Uniport video-assisted thoracoscopic surgery (VATS) via the subxiphoid approach has emerged as a safe and effective treatment for anterior mediastinal tumors. However, there is limited evidence of the necessity of chest tubes and the comparative efficacy with other approaches. Methods A total of 141 patients with anterior mediastinal tumors receiving VATS were enrolled in this retrospective study. The patients were divided into the lateral approach (LA) group, the uniport subxiphoid approach (USA) group, and the three-port subxiphoid approach (TSA) group. Short-term analysis including operation time, chest tube rates, drainage duration, visual analogue scale (VAS) score, and hospital stay were compared. Postoperative CT scans were analyzed to evaluate the amount of pleural effusion. Results There was no significant difference in demographic and baseline characteristics among the three groups (all P>0.05). The operation time, blood loss, and hospital stay of the subxiphoid approach group were significantly lower than the LA group (P<0.001). The postoperative CT scans demonstrated that the USA group had a similar amount of pleural effusion as the other groups (P=0.1605). The postoperative VAS score of the USA group was significantly lower than the other groups (P<0.001). There was no significant difference in complications, in-hospital death, and conversion to thoracotomy among the three groups (all P>0.05). Conclusions VATS via the subxiphoid approach is less invasive, equally safe, and same effective for anterior mediastinal tumors than the LA. The chest tube could be omitted for the USA.
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Affiliation(s)
- Min Cao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Wang
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hang Yin
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujie Fu
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Pan J, Chen W, Zhang H, Huang X, Huang X. Contrast-Enhanced Ultrasonography versus Contrast-Enhanced Magnetic Resonance Imaging in the Diagnosis of Mediastinal Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:261-271. [PMID: 33153806 DOI: 10.1016/j.ultrasmedbio.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/09/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023]
Abstract
The aim of the study was to evaluate and compare contrast-enhanced ultrasound (CEUS) and contrast-enhanced magnetic resonance imaging (CE-MRI) with respect to their value in the differential diagnosis between benign and malignant mediastinal tumors. Forty-two patients with mediastinal tumor underwent CEUS and CE-MRI respectively. The sensitivity, specificity, diagnostic coincidence rate, positive predictive value (PPV) and negative predictive value of the two methods were compared. The value of different enhancement patterns in the differential diagnosis of benign and malignant mediastinal tumors was analyzed. SonoLiver software was used to obtain the dynamic vascular pattern curve (DVPC) of the lesions, and parameters such as arrival time (AT), rise time (RT), time to peak (TTP), maximum intensity/peak intensity (IMAX) and quality of fit (QOF) were extracted from time-intensity curves for quantitative analysis. We found that (i) the specificity of CEUS was higher than that of CE-MRI, and the PPV and diagnostic coincidence rate of CEUS were equal to those of CE-MRI; (ii) the enhancement patterns and DVPC of CEUS differed between the benign and malignant groups, while there was no difference in CE-MRI enhancement intensity; and (iii) AT, RT and TTP in the malignant groups were significantly shorter, while IMAX was significantly higher. In conclusion, the application of quantitative parameters and DVPC of CEUS is worth popularizing. CEUS can be used as an effective alternative and complementary examination for patients who cannot undergo CE-MRI.
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Affiliation(s)
- Juhong Pan
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wenwei Chen
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Haidong Zhang
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xingyue Huang
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xin Huang
- Department of Ultrasound, Renmin Hospital of Wuhan University, Wuhan, China
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Rabiou S, Lakranbi M, Ghizlane T, Elfatemi H, Serraj M, Ouadnouni Y, Smahi M. [Which surgery for mediastinum tumor: Experience of the Department of thoracic surgery of CHU Hassan II of Fès]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:246-252. [PMID: 28838625 DOI: 10.1016/j.pneumo.2017.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 04/11/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Tumors of the mediastinum are a heterogeneous group of dysembryoplatic and neoplastic diseases essentially with different prognoses and therapeutic. These tumors develop slowly and remain long asymptomatic in 40-50% of cases. The purpose of our work is to bring the result of surgical management in diagnostic and therapeutic of principal mediastinum tumors framework. PATIENTS AND METHOD We reviewed retrospectively the records of 68 patients in our training, between January 2009 and December 2013, for tumor of the mediastinum in the diagnostic framework and or therapy. RESULTS There were 37 men and 31 women with a mean age of 37 years with extremes ranging from 11 to 73 years and 77.94% had an age between 11 and 50. In 39 patients, surgery had a diagnostic purpose (2 benign tumors and 37 malignancies including 27 cases of lymphomas). Curative surgery was performed in 34 patients, dominated by the tumors of thymic origin in 15 cases. Conventional surgery had involved 32 patients. The surgical approach was a total vertical sternotomy in 14 patients, in 17 patients was posterolateral thoracotomy and a left anterior thoracotomy in 1 patient. Video assisted thoracic surgery had been done in 3 patients under resection of a pleuropericardique cyst. Overall mortality was 4.41 percent. It is a death at D17 of the postoperative (thymoma with myasthenia) following a myasthenic crisis requiring a tracheotomy. A patient operated on for invasive thymoma developed myopathy and died at D44 of the postoperative following a difficulty of weaning. Another patient had a thymoma B3 benefited from 6 courses of neoadjuvant chemotherapy and then a thymectomy had presented a respiratory distress with bilateral pleural effusion, death at D10 of the postoperative by septic shock following a nosocomial infection. CONCLUSION Tumors of the mediastinum are infrequent, discovered more often by chance. The main prognostic factor is the completeness of tumor resection without taking the break. Conventional surgery always keeps a place in our context, despite the advent of minimally invasive surgery.
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Affiliation(s)
- S Rabiou
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc.
| | - M Lakranbi
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc
| | - T Ghizlane
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc
| | - H Elfatemi
- Service d'anatomie et cytologie pathologiques, CHU Hassan II, Fès, Maroc; Faculté de médecine et pharmacie, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - M Serraj
- Servie de pneumologie, CHU Hassan II, Fès, Maroc; Faculté de médecine et pharmacie, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc; Faculté de médecine et pharmacie, université Sidi Mohamed Ben Abdellah, Fès, Maroc
| | - M Smahi
- Service de chirurgie thoracique, CHU Hassan II, Fès, Maroc; Faculté de médecine et pharmacie, université Sidi Mohamed Ben Abdellah, Fès, Maroc
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Li Z, Jia H, Zhang B, Zhang Y, Li H, Song P. The clinical features, treatment, and prognosis of primary mediastinal malignant melanoma: A case report. Medicine (Baltimore) 2017; 96:e6436. [PMID: 28445254 PMCID: PMC5413219 DOI: 10.1097/md.0000000000006436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Primary malignant melanoma (MM) of the mediastinum is exceedingly rare; a review of the English-language literature reveals only a small number of case reports. In this paper, we discuss a case of primary mediastinal MM and present a review of the relevant literature on its clinical features and treatment. PATIENT CONCERNS A 52-year-old male presenting with back pain was admitted to our hospital for treatment. Imaging examination revealed an anterior mediastinal mass and no evidence of other metastatic or primary lesions. DIAGNOSES After complete resection by video-assisted thoracoscopic surgery (VATS), histopathologic examination showed evidence of brown melanin pigment in the tumor cells, which were immunohistochemically positive for antimelanoma antibodies (HMB-45, Melan-A, S-100, and Ki67). INTERVENTIONS Given the diagnosis of MM after surgery, the tumor was tested for the mutation in the BRAF gene (which encodes the serine/threonine-protein kinase B-raf) that leads to a V600E amino acid substitution, and the tumor was found to be wild type. Then the patient has been given immunotherapy. OUTCOMES The patient completed 4 cycles of immunotherapy, and no recurrence or metastasis has been detected to date. LESSONS In such cases, it is difficult to prove the primary nature of the intrathoracic melanoma. Moreover, preoperative identification of this disease is challenging, making misdiagnosis likely. Due to fast progression and poor prognosis, timely and effective systemic treatment is necessary to improve the outcomes for patients with primary mediastinal MM.
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Affiliation(s)
- ZiHai Li
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences
- Department of Thoracic Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China
| | - Hui Jia
- Department of Medical Oncology
| | - Baijiang Zhang
- Department of Thoracic Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China
| | - Yongming Zhang
- Department of Thoracic Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China
| | - Hui Li
- Department of Thoracic Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China
| | - Pingping Song
- Department of Thoracic Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong Province, People's Republic of China
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Issoufou I, Lakranbi M, Sani R, Belliraj L, Ammor FZ, Ghalimi J, Ouadnouni Y, Smahi M. [Neurogenic mediastinal tumors in adults]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:310-315. [PMID: 27567980 DOI: 10.1016/j.pneumo.2016.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 05/11/2016] [Accepted: 05/17/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Neurogenic mediastinal tumors are tumors develop at the expense of peripheral nerve elements of the mediastinum, the sympathetic nervous tissue and paraganglia. The series that we propose has the distinction of a high frequency of malignant forms and a wealth of clinical symptomatology. METHODS This is a retrospective study of 9 patients collected over a period of 6 years. The epidemiological aspect, clinical, radiological, surgical treatment and his results, histological diagnosis and prognosis were reviewed. RESULTS Five women and 4 men were identified. All patients were symptomatic at diagnosis. Tumor resection was complete in 8 cases. In 3 patients, there was a malignant tumor. Two of them had received chemo-radiotherapy. The others showed good clinical progress with a mean of 35 months. CONCLUSION Neurogenic tumors in adults are usually discovered incidentally. When the malignant forms predominate or in the presence of large tumor, the symptoms can be quite marked. In all cases the treatment based on a complete surgical resection remains the only guarantee of a good prognosis.
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Affiliation(s)
- I Issoufou
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, km 2200, route de Sidi Hrazem, 3000 Fes Maroc.
| | - M Lakranbi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, km 2200, route de Sidi Hrazem, 3000 Fes Maroc
| | - R Sani
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, km 2200, route de Sidi Hrazem, 3000 Fes Maroc
| | - L Belliraj
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, km 2200, route de Sidi Hrazem, 3000 Fes Maroc
| | - F Z Ammor
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, km 2200, route de Sidi Hrazem, 3000 Fes Maroc
| | - J Ghalimi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, km 2200, route de Sidi Hrazem, 3000 Fes Maroc
| | - Y Ouadnouni
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, km 2200, route de Sidi Hrazem, 3000 Fes Maroc
| | - M Smahi
- Service de chirurgie thoracique, CHU Hassan II, BP 1893, km 2200, route de Sidi Hrazem, 3000 Fes Maroc
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