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Gan W, Yang MZ, Tan ZH, Xie CL, Sun TY, Yang HX. Robotic portal resection for mediastinal tumours: a prospective observational study. J Cardiothorac Surg 2024; 19:155. [PMID: 38532497 DOI: 10.1186/s13019-024-02660-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/19/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND To demonstrate the effectiveness and feasibility of robotic portal resection (RPR) for mediastinal tumour using a prospectively collected database. METHODS Data from 73 consecutive patients with mediastinal tumours who underwent RPRs were prospectively collected from August 2018 to April 2023. All patients underwent chest and abdominal enhanced computed tomography (CT) and preoperative multidisciplinary team (MDT) discussion. The patients were stratified into two groups based on tumour size: Group A (tumour size < 4 cm) and Group B (tumour size ≥ 4 cm). General clinical characteristics, surgical procedures, and short outcomes were promptly recorded. RESULTS All of the cases were scheduled for RPRs. One patient (1/73, 1.4%) was switched to a small utility incision approach because of extensive pleural adhesion. Two patients (2.8%) converted to sternotomy, however, no perioperative deaths occurred. Most of the tumours were located in the anterior mediastinum (51/73, 69.9%). Thymoma (27/73, 37.0%) and thymic cyst (16/73, 21.9%) were the most common diagnoses. The median diameter of tumours was 3.2 cm (IQR, 2.4-4.5 cm). The median total operative time was 61.0 min (IQR, 50.0-90.0 min). The median intraoperative blood loss was 20 mL (IQR, 5.0-30.0 ml), and only one patient (1.4%) experienced an intraoperative complication. The median length of hospital stay was 3 days (IQR, 2-4 days). Compared with Group A, the median total operative time and console time of Group B were significantly longer (P = 0.006 and P = 0.003, respectively). The volume of drainage on the first postoperative day was greater in group B than in group A (P = 0.013). CONCLUSION RPR is a safe and effective technique for mediastinal tumour treatment, which can expand the application of minimally invasive surgery for the removal of complicated mediastinal tumours.
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Affiliation(s)
- Wei Gan
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
| | - Mu-Zi Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
| | - Zi-Hui Tan
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
| | - Chu-Long Xie
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
| | - Tian-Yu Sun
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China
| | - Hao-Xian Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou City, Guangdong Province, 510060, P.R. China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China.
- Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P.R. China.
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Liu Y, Xia N, Duan Y, Wu X, Zhao C, Jin C, Chen X, Gao Q, Wang Y, Wang F, Wang F, Chen Y, Dong Q, Hao X. Application of computer-assisted surgery in pediatric mediastinal tumor surgery. Int J Med Robot 2023; 19:e2489. [PMID: 36471636 DOI: 10.1002/rcs.2489] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/19/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Computer-assisted Surgery system (CAS) is an effective medical imaging simulation tool, which is widely used in preoperative planning of surgery. The objective of this study is to investigate the clinical application of CAS in pediatric mediastinal tumor resection. METHODS This retrospective study investigated 74 children who underwent mediastinal tumor resection between June 2008 and June 2022 at the pediatric surgical center of the Affiliated Hospital of Qingdao University and Qingdao Women and Children's Hospital. Preoperative chest computed tomography imaging was performed on all children. A total of 44 children (the CAS-assisted group) underwent clinical image 3D reconstruction and preoperative simulation using Hisense CAS. The control group consisted of 30 children who underwent a conventional procedure without CAS. The demographic, preoperative, and complication data were analyzed and compared between the two groups. t-test, Mann-Whitney U test, X2 test, or Fisher's exact test were used accordingly in this study during analysis. RESULTS The median operative duration was 119.00 min in the CAS-assisted group and 140.50 min in the control group. The median intraoperative blood loss of the CAS-assisted group and the control group was 14.00 and 31.00 ml respectively. Relative to the control groups, the CAS-assisted group experienced shorter operative duration time (p = 0.041), and less intraoperative blood loss (p < 0.001). The difference in postoperative drain indwelling between the CAS-assisted group (median:4.00 days) and the control group (median:7.00 days) reached a statistical significance (p = 0.001). And the duration of hospitalization after the operation for the CAS-assisted group (median:7.00 days) was shorter than that for the control group (median:9.00 days) (p = 0.001). No significant difference could be found in the rate of blood transfusion (p = 0.258) and the incidence of postoperative complications (p = 0.719) between the two groups. CONCLUSION Hisense CAS could effectively assist surgeons to clearly determine the anatomical site of tumors and provide accurate preoperative simulation for surgeons, so as to assist surgeons to specify effective surgical plans for patients.
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Affiliation(s)
- Yao Liu
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Nan Xia
- Institute for Digital Medicine and Computer-assisted Surgery in Qingdao University, Qingdao, China.,Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Qingdao, China
| | - Yuhe Duan
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiongwei Wu
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chunyang Zhao
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chen Jin
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xue Chen
- Institute for Digital Medicine and Computer-assisted Surgery in Qingdao University, Qingdao, China
| | - Qiang Gao
- Department of Pediatric Surgery, The Qingdao Women and Children's Hospital, Qingdao, China
| | - Yingming Wang
- Department of Pediatric Surgery, The Qingdao Women and Children's Hospital, Qingdao, China
| | - Feifei Wang
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Qingdao, China
| | - Fengjiao Wang
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Qingdao, China
| | - Yongjian Chen
- Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Qingdao, China.,Qingdao Hisense Medical Equipment Co., Ltd, Qingdao, China
| | - Qian Dong
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,Shandong Provincial Key Laboratory of Digital Medicine and Computer-assisted Surgery, Qingdao, China
| | - Xiwei Hao
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Liufu Y, Wen Y, Wu W, Su R, Liu S, Li J, Pan X, Chen K, Guan Y. Radiomics Analysis of Multiphasic Computed Tomography Images for Distinguishing High-Risk Thymic Epithelial Tumors From Low-Risk Thymic Epithelial Tumors. J Comput Assist Tomogr 2023; 47:220-228. [PMID: 36877755 DOI: 10.1097/rct.0000000000001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES The objective of this study is to preoperatively investigate the value of multiphasic contrast-enhanced computed tomography (CT)-based radiomics signatures for distinguishing high-risk thymic epithelial tumors (HTET) from low-risk thymic epithelial tumors (LTET) compared with conventional CT signatures. MATERIALS AND METHODS Pathologically confirmed 305 thymic epithelial tumors (TETs), including 147 LTET (Type A/AB/B1) and 158 HTET (Type B2/B3/C), were retrospectively analyzed, and were randomly divided into training (n = 214) and validation cohorts (n = 91). All patients underwent nonenhanced, arterial contrast-enhanced, and venous contrast-enhanced CT analysis. The least absolute shrinkage and selection operator regression with 10-fold cross-validation was performed for radiomic models building, and multivariate logistic regression analysis was performed for radiological and combined models building. The performance of the model was evaluated by the area under the receiver operating characteristic curve (AUC of ROC), and the AUCs were compared using the Delong test. Decision curve analysis was used to evaluate the clinical value of each model. Nomogram and calibration curves were plotted for the combined model. RESULTS The AUCs for radiological model in the training and validation cohorts were 0.756 and 0.733, respectively. For nonenhanced, arterial contrast-enhanced, venous contrast-enhanced CT and 3-phase images combined radiomics models, the AUCs were 0.940, 0.946, 0.960, and 0.986, respectively, in the training cohort, whereas 0.859, 0.876, 0.930, and 0.923, respectively, in the validation cohort. The combined model, including CT morphology and radiomics signature, showed AUCs of 0.990 and 0.943 in the training and validation cohorts, respectively. Delong test and decision curve analysis showed that the predictive performance and clinical value of the 4 radiomics models and combined model were greater than the radiological model ( P < 0.05). CONCLUSIONS The combined model, including CT morphology and radiomics signature, greatly improved the predictive performance for distinguishing HTET from LTET. Radiomics texture analysis can be used as a noninvasive method for preoperative prediction of the pathological subtypes of TET.
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Affiliation(s)
- Yuling Liufu
- From the Department of Radiology, The Fifth Affiliated Hospital of Guangzhou Medical University
| | - Yanhua Wen
- From the Department of Radiology, The Fifth Affiliated Hospital of Guangzhou Medical University
| | - Wensheng Wu
- From the Department of Radiology, The Fifth Affiliated Hospital of Guangzhou Medical University
| | - Ruihua Su
- From the Department of Radiology, The Fifth Affiliated Hospital of Guangzhou Medical University
| | - Shuya Liu
- From the Department of Radiology, The Fifth Affiliated Hospital of Guangzhou Medical University
| | - Jingxu Li
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University
| | - Xiaohuan Pan
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University
| | - Kai Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yubao Guan
- From the Department of Radiology, The Fifth Affiliated Hospital of Guangzhou Medical University
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Lacquet M, Moons J, Ceulemans LJ, De Leyn P, Van Raemdonck D. Surgery for mediastinal neurogenic tumours: a 25-year single-centre retrospective study. Interact Cardiovasc Thorac Surg 2021; 32:737-743. [PMID: 33517410 DOI: 10.1093/icvts/ivab002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Mediastinal neurogenic tumours are uncommon and often benign neoplasms mostly located in the posterior mediastinum and usually diagnosed incidentally. We reviewed our results after surgical resection. We compared patient characteristics and tumour nature between children and adults. Differences between thoracoscopic and open approach were analysed. METHODS Departmental thoracic surgical database was queried for primary mediastinal neurogenic tumours resected between 1992 and 2017. Data included demographics, pathology, tumour nature, symptoms, surgical approach and postoperative morbidity/mortality. RESULTS Fifty-one patients (8 children and 43 adults) underwent tumour resection. Pathology revealed nerve sheath tumour in 1 child (12.5%) versus 36 adults (83.7%; P < 0.001) and ganglion cell tumour in 7 (87.5%) versus 5 (11.6%; P < 0.001). Two adults had a paraganglioma. Malignancy was present in 2 children (25%) versus 2 adults (4.6%; P = 0.049). All malignant tumours caused symptoms while most patients with benign tumours (38/47) were asymptomatic (P < 0.001). Surgical approach included thoracotomy, thoracoscopy and cervicotomy (n = 19/31/1) of which 2 were combined neurosurgical approach. All malignant tumours were approached via thoracotomy while the majority of patients with benign tumours (31/47) underwent thoracoscopy (P = 0.007). No significant difference was noted in overall morbidity between thoracoscopic versus open approach (45.2% vs 42.1%; P = 0.83). Hospital stay was significantly shorter following thoracoscopy (7.4 ± 3.3 vs 13.1 ± 9.8 days; P = 0.001). CONCLUSIONS Children carry a higher incidence to present with a malignant tumour originating from ganglion cells while most tumours in adults are benign, originating from the nerve sheath. The majority of patients with mediastinal neurogenic tumours are asymptomatic. Most tumours are amenable for thoracoscopic resection.
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Affiliation(s)
- Mathieu Lacquet
- Surgical Resident, Competence Center for Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE), Catholic University Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE), Catholic University Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory for Respiratory Diseases and Thoracic Surgery (BREATHE), Catholic University Leuven, Leuven, Belgium
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Nosrati R, Anissian D, Ramezani F, Sharbatdaran M. Benign schwannoma of posterior mediastinum accompanied by bloody pleural effusion misdiagnosed as solitary fibrous tumor: A case report. CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:468-471. [PMID: 31814948 PMCID: PMC6856921 DOI: 10.22088/cjim.10.4.468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Schwannoma is a peripheral nerve sheath tumor originating from schwann cells. It is the most common neurogenic tumor of the posterior mediastinum. Pleural effusion is a rare presentation of benign schwannoma and it is mainly related to malignant tumors. Histologically, schwannoma as well as solitary fibrous tumor should be considered as a differential diagnosis of spindle cell lesions. Case presentation: Here, we report a case of an asymptomatic 61-year-old female misdiagnosed as solitary fibrous tumor of posterior mediastinum which was revealed to have blood stained pleural effusion during the video-assisted thoracic surgery. Eventually pathological study and immunohistochemistry profile of the tumor was reported as benign schwannoma. Conclusion: This report indicates that benign schwannoma can be accompanied by bloody pleural effusion and it also emphasizes the role of immunohistochemistry in the diagnosis of biopsy specimen of spindle cell lesions.
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Affiliation(s)
- Ramin Nosrati
- Department of Surgery, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Diana Anissian
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Farangis Ramezani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Majid Sharbatdaran
- Department of Pathology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
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Giant epidermal inclusion cyst masquerading as a soft tissue sarcoma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abdel Rahman ARM, Rahouma M, Gaafar R, Bahaa S, Loay I, Kamel M, Abdelbaki H, Yahia M. Contributing factors to the outcome of primary malignant chest wall tumors. J Thorac Dis 2018; 9:5184-5193. [PMID: 29312725 DOI: 10.21037/jtd.2017.11.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Primary malignant chest-wall tumors (PMCWTs) are a heterogeneous group of tumors. They require a special experience in designing resection and reconstruction. They account for less than 1% of all primary malignant tumors. This study is designed to clarify different factors contributing to the outcome of patients with PMCWTs in our institution. Methods A retrospective study included 98 patients with pathology proven PMCWTs, treated at the National Cancer Institute (NCI), Cairo University, Egypt, during the past 10 years. Used variables were: age, sex, forced expiratory volume in the 1st second (FEV1), site, size, multiplicity, pathologic subtype, tumor grade, safety margin (SM), excised ribs, complications, estimated blood loss (EBL), neo-adjuvant and adjuvant treatments, Overall and disease free survival (DFS) were obtained using Kaplan-Meier method and compared using Log rank test. Cox regression was used to identify DFS predictors. Results PMCWTs represented 10.5% of all thoracic malignancies in our institution. There were 51 females (52%). The median age was 39 years [interquartile range (IQR) =25-52.3)] years. Chondrosarcoma was the commonest tumor histology (20.4%). The median tumor size was 8 cm (IQR =5-14). Tumor multiplicity was found in 18.4% of patients. Bone resection was performed in 76 patients (78.3%), ribs resection was performed in 59 patients and the median number of resected ribs per patient was 3 (IQR =1-3) ribs. Sternal resection was done in 7 (7.1%) cases. R0 resection was achieved in 62.2% of patients. There was one operative related mortality (1.02%) and 17.3% patients suffered procedure related complications. Local recurrence developed in 35 (35.7%) patients. The overall survival (OS) at 1, 3 and 5 years was 73.9%, 45.6% and 34.6% respectively and the median OS was 33 months (95% CI, 21.8-44.2), while median DFS was 24 months (95% CI, 19.6-28.4). Predictors of better DFS were -ve SM (P<0.001), tumors <5 cm (P=0.039), low grade (P=0.033), lower EBL (P=0.003) and absence of adjuvant therapy (P=0.007); however, on multivariate analysis, only -ve SM was the only predictor (HR =0.54; 95% CI, 0.29-0.97, P=0.041). Conclusions In primary malignant CWTs (PMCWTs) achievement of wide resection margins is of great importance to minimize the local tumor recurrence that will have an adverse impact on long-term survival.
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Affiliation(s)
| | - Mohamed Rahouma
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Rabab Gaafar
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Sherif Bahaa
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Iman Loay
- Cancer Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Kamel
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hoda Abdelbaki
- Radiation Therapy Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Maha Yahia
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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de Oliveira KF, Rodrigues MM, Lopes GP, de Almeida RS, Lusvarghi JL, dos Santos JPV. Massive thymoma of the mid-posterior mediastinum: an unprecedented case in a young adult. Radiol Bras 2016; 49:403-405. [PMID: 28057967 PMCID: PMC5210037 DOI: 10.1590/0100-3984.2014.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 06/20/2014] [Indexed: 11/22/2022] Open
Abstract
We report an unprecedented case of ectopic thymoma in a young adult. A 33-year-old male presented with a 10-day history of non-productive cough and fever. Investigation revealed mediastinal widening without pulmonary involvement. Computed tomography showed a large mass-14.8 × 10.8 × 8.4 cm-in the mid-posterior mediastinum, and a biopsy obtained by video-assisted thoracoscopy indicated that the mass was a tumor. Immunohistochemistry showed combined thymoma type AB1. Because of the considerable proportions of the tumor and its close proximity to major structures, the patient was treated with chemotherapy.
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Affiliation(s)
| | - Marcio Maciel Rodrigues
- Fellow in Oncological Radiology at the Instituto do
Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp),
São Paulo, SP, Brazil
| | - Gesner Pereira Lopes
- Head of the Department of Radiology and Diagnostic
Imaging at the Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG,
Brazil
| | - Renan Sandoval de Almeida
- MD, Resident in Clinical Medicine at the Universidade
Federal de Uberlândia (UFU), Uberlândia, MG, Brazil
| | | | - João Paulo Vieira dos Santos
- Thoracic Surgeon at the Hospital de Clínicas da
Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
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Martos-Martínez JM, Sacristán-Pérez C, Pérez-Andrés M, Durán-Muñoz-Cruzado VM, Pino-Díaz V, Padillo-Ruiz FJ. Prevertebral cervical approach: a pure endoscopic surgical technique for posterior mediastinum parathyroid adenomas. Surg Endosc 2016; 31:1930-1935. [PMID: 27553796 DOI: 10.1007/s00464-016-5197-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/17/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Parathyroid gland mediastinal ectopia is an unusual but challenging condition in surgical management of hyperparathyroidism. Posterior mediastinum parathyroid ectopia is rare, and glands need to be removed either with a broad open cervical or thoracic approach. In recent years, several minimally invasive approaches to mediastinal parathyroid glands have been described, but for posterior mediastinum adenomas, proposed techniques are transthoracic. METHODS The aim of this paper is to describe, to our best knowledge for the first time, a standardized pure endoscopic cervical technique to approach posterior mediastinal parathyroid adenomas which we have used in three patients. RESULTS The technique was applied in three patients which excellent surgical, postoperative, and cosmetic results. CONCLUSIONS Endoscopic prevertebral approach is a feasible, sure and inexpensive standardized pure endoscopic cervical approach to posterior mediastinal parathyroid adenomas, which may result in a less aggressive surgical option when compared with thoracic approaches.
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Affiliation(s)
- Juan Manuel Martos-Martínez
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain.
| | - Cristina Sacristán-Pérez
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
| | - Marina Pérez-Andrés
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
| | | | - Verónica Pino-Díaz
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
| | - Francisco Javier Padillo-Ruiz
- General and Digestive Surgery Department, Virgen del Rocío University Hospital, Avda, Manuel Siurot S/N, 41013, Seville, Spain
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Li WWL, van Boven WJP, Annema JT, Eberl S, Klomp HM, de Mol BAJM. Management of large mediastinal masses: surgical and anesthesiological considerations. J Thorac Dis 2016; 8:E175-84. [PMID: 27076967 DOI: 10.21037/jtd.2016.02.55] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Large mediastinal masses are rare, and encompass a wide variety of diseases. Regardless of the diagnosis, all large mediastinal masses may cause compression or invasion of vital structures, resulting in respiratory insufficiency or hemodynamic decompensation. Detailed preoperative preparation is a prerequisite for favorable surgical outcomes and should include preoperative multimodality imaging, with emphasis on vascular anatomy and invasive characteristics of the tumor. A multidisciplinary team should decide whether neoadjuvant therapy can be beneficial. Furthermore, the anesthesiologist has to evaluate the risk of intraoperative mediastinal mass syndrome (MMS). With adequate preoperative team planning, a safe anesthesiological and surgical strategy can be accomplished.
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Affiliation(s)
- Wilson W L Li
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Wim Jan P van Boven
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Jouke T Annema
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Susanne Eberl
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Houke M Klomp
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Bas A J M de Mol
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
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Lin GQ, Li YQ, Huang LJ, Luo FY, Jiang HH, Luo WJ. Chest wall tumors: Diagnosis, treatment and reconstruction. Exp Ther Med 2015; 9:1807-1812. [PMID: 26136897 DOI: 10.3892/etm.2015.2353] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 01/12/2015] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to determine a suitable procedure for the treatment of chest wall neoplasms with less potential risk and an increased rate of survival. Fifty patients with suspected chest wall malignancies were analyzed using various preliminary investigation tools. Whole-chest scanning was performed in all the patients. The patients were subsequently subjected to biopsies for further confirmation of the neoplasm. All such patients were then treated with a surgical approach and radiation therapy, with a follow-up period lasting up to six years. The majority of the patients showed improved survival rates relative to conventional therapies. The survival rates of patients suffering from osteosarcoma (78%) were higher those of patients with rhabdomyosarcoma (73%) and malignant small round cell tumors (64%). The survival and the mortality rates of the patients with synovial sarcoma and fibrosarcoma were the same. This study, which was conducted on a small group of patients, has provided guidance for further studies on tumors of the chest wall, which may, in turn, increase the longevity of affected patients.
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Affiliation(s)
- Guo-Qiang Lin
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Ying-Qiu Li
- Faculty of Basic Medicine, Hunan University of Traditional Chinese Medicine, Changsha, Hunan 410008, P.R. China
| | - Ling-Jin Huang
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Fan-Yan Luo
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Hai-He Jiang
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Wan-Jun Luo
- Department of Cardiothoracic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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Li WW, van Boven WJ, Jurhill RR, Bonta PI, Annema JT, de Mol BA. Ectopic pancreas in a giant mediastinal cyst. CLINICAL RESPIRATORY JOURNAL 2014; 10:125-8. [DOI: 10.1111/crj.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 05/25/2014] [Accepted: 06/22/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Wilson W. Li
- Department of Cardiothoracic Surgery; University of Amsterdam; Amsterdam the Netherlands
| | - Wim Jan van Boven
- Department of Cardiothoracic Surgery; University of Amsterdam; Amsterdam the Netherlands
| | - Roy R. Jurhill
- Department of Pathology; University of Amsterdam; Amsterdam the Netherlands
| | - Peter I. Bonta
- Department of Respiratory Medicine, Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - Jouke T. Annema
- Department of Respiratory Medicine, Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - Bas A. de Mol
- Department of Cardiothoracic Surgery; University of Amsterdam; Amsterdam the Netherlands
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13
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Wigmore TJ, Farquhar-Smith P, Lawson A. Intensive care for the cancer patient - unique clinical and ethical challenges and outcome prediction in the critically ill cancer patient. Best Pract Res Clin Anaesthesiol 2013; 27:527-43. [PMID: 24267556 DOI: 10.1016/j.bpa.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
With the rising number of cancer cases and increasing survival times, cancer patients with critical illness are increasingly presenting to the intensive care unit. This article considers the unique challenges they pose in terms of oncological-specific disease processes and treatment and reviews current trends in outcome prediction. We also consider the ethical standpoints surrounding the treatment of patients for whom there may be no cure and their subsequent transition to palliative care, should it become necessary.
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