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Peters EJ, Buduhan G, Tan L, Srinathan SK, Kidane B. Preoperative quality of life predicts complications in thoracic surgery: a retrospective cohort study. Eur J Cardiothorac Surg 2024; 66:ezae301. [PMID: 39133147 DOI: 10.1093/ejcts/ezae301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/23/2024] [Accepted: 08/09/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVES Patients undergoing thoracic surgery experience high complication rates. It is uncertain whether preoperative health-related quality of life (HRQOL) measurements can predict patients at higher risk for postoperative complications. The objective of this study was to determine the association between preoperative HRQOL and postoperative complications among patients undergoing thoracic surgery. METHODS This was a retrospective cohort study of prospectively collected data. Consecutive patients undergoing elective thoracic surgery at a Canadian tertiary care centre between January 2018 and January 2019 were included. Patient HRQOL was measured using the Euroqol-5 Dimension (EQ-5D) survey. Complications were recorded using the Ottawa Thoracic Morbidity and Mortality system. Uni- and multivariable analysis were performed. RESULTS Of 515 surgeries performed, 133 (25.8%) patients experienced at least 1 postoperative complication; 345 (67.0%) patients underwent surgery for malignancy. A range of 271 (52.7%) to 310 (60.2%) patients experienced pain/discomfort at each timepoint. On multivariable analysis, lower preoperative EQ-5D visual analogue scale scores were significantly associated with postoperative complications (adjusted odds ratio 0.97, 95% confidence interval 0.95-0.99; P = 0.01). Presence of malignancy was not independently associated with complications (P = 0.68). CONCLUSIONS Self-reported preoperative HRQOL can predict incidence of postoperative complications among patients undergoing thoracic surgery. Assessments of preoperative HRQOL may help identify patients at higher risk for developing complications. These findings could be used to direct preoperative risk-mitigation strategies in areas of HRQOL where patients suffer most, such as pain. The full perioperative trajectory of patient HRQOL should be discerned to identify subsets of patients who share common risk factors.
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Affiliation(s)
- Eagan J Peters
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Gordon Buduhan
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lawrence Tan
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sadeesh K Srinathan
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba Research Institute, University of Manitoba, Winnipeg, MB, Canada
- Department of Physiology & Pathophysiology, University of Manitoba, Winnipeg, MB, Canada
- Department of Biomedical Engineering, University of Manitoba, Winnipeg, MB, Canada
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Cariboni U, Monti L, Voulaz E, Civilini E, Citterio E, Lisi C, Marulli G. Role of Cine-Magnetic Resonance Imaging in the Assessment of Mediastinal Masses with Uncertain/Equivocal Findings from Pre-Operative Computed Tomography Scanning. Diagnostics (Basel) 2024; 14:1682. [PMID: 39125558 PMCID: PMC11311384 DOI: 10.3390/diagnostics14151682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/25/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Malignant neoplasms originating from or involving the mediastinum represent a diagnostic and therapeutic challenge when they are in contact with nearby cardiovascular structures. We aimed to test the diagnostic accuracy of cine-magnetic resonance imaging (cine-MRI) in detecting the infiltration of cardiovascular structures in cases with uncertain or equivocal findings from contrast-enhanced Computed Tomography (CT) scanning. METHODS Fifty patients affected by tumors with a suspected invasion of mediastinal cardiovascular structures at the pre-operative chest CT scan stage underwent cine-MRI before surgery at our Institution. Intraoperative findings and the histological post-surgical report were used as a reference standard to define infiltration. Inter- and intra-observer agreement for CT scans and cine-MRI were also computed over a homogenous sample of 14 patients. RESULTS Cine-MRI had a higher negative predictive value (93% vs. 54%, p < 0.001) than CT scans, higher sensitivity (91% vs. 16%, p < 0.001), as well as greater accuracy (66% vs. 50%, p < 0.001) in detecting cardiovascular invasion. Cine-MRI also showed better inter- and intra-observer agreement for infiltration detection. CONCLUSIONS Cine-MRI outperforms conventional contrast-enhanced chest CT scans in the preoperative assessment of cardiovascular infiltration by mediastinal or pulmonary tumors, making it a useful imaging modality in the preoperative staging and evaluation of patients with equivocal findings at the chest CT scan stage.
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Affiliation(s)
- Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy (E.V.)
| | - Lorenzo Monti
- Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Emanuele Voulaz
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy (E.V.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (E.C.)
| | - Efrem Civilini
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (E.C.)
- Division of Vascular Surgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Enrico Citterio
- Division of Cardiac Surgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (E.C.)
- Department of Diagnostic and Interventional Radiology, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Giuseppe Marulli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy (E.V.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy; (E.C.)
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Suwal S, Katwal S, Lamichhane S, Chataut D, Bhusal A, Sharma A. Pericardial hydatid cyst: A comprehensive case report on diagnosis and multidisciplinary intervention in a young patient. Radiol Case Rep 2024; 19:2832-2836. [PMID: 38689818 PMCID: PMC11059308 DOI: 10.1016/j.radcr.2024.03.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 05/02/2024] Open
Abstract
Pericardial hydatid cysts, although rare, present unique diagnostic challenges and require a multidisciplinary approach for effective management. This parasitic infection, caused by Echinococcus granulosus larvae, typically affects the liver and lungs but can manifest in the pericardium, leading to potentially life-threatening complications if untreated. The 22-year-old female's escalating dyspnea posed diagnostic challenges despite inconclusive echocardiography. Employing a multidisciplinary strategy, including preoperative albendazole therapy and surgical excision, effectively managed the condition. This case highlights the intricate diagnostic nature of pericardial hydatid cysts, emphasizing the importance of heightened clinical awareness, especially in endemic regions. The detailed clinical trajectory, imaging methodologies, and therapeutic interventions contribute significant insights to the medical community. The study aims to deepen comprehension and guide clinicians in refined diagnostic and treatment approaches for pericardial hydatid cysts, ultimately improving patient outcomes. It underscores the imperative for continued research in this niche to enhance medical understanding and optimize clinical practices.
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Affiliation(s)
- Sundar Suwal
- Department of Radiology, Maharajgunj Medical College, Kathmandu, Nepal
| | - Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura, Nepal
| | - Suman Lamichhane
- Department of Radiology, Nepal A.P.F. Hospital, Kathmandu, Nepal
| | - Dinesh Chataut
- Department of Radiology, Maharajgunj Medical College, Kathmandu, Nepal
| | - Amrit Bhusal
- Department of Radiology, BP Koirala Institute of Health Sciences, Sunsari, Nepal
| | - Aakriti Sharma
- Department of Cardiothoracic Surgery, Manmohan Cardiac, Vascular and Transplant Center, Kathmandu, Nepal
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4
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Rouabeh W, Chrigui R, Imen M, Nawwar N, Cherif T, Radhia BB. Cardiopulmonary bypass for anesthetic management anterior medistinal teratoma: Case report. Int J Surg Case Rep 2024; 119:109575. [PMID: 38759398 PMCID: PMC11127553 DOI: 10.1016/j.ijscr.2024.109575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Perioperative anesthetic management in cases of severe airway obstruction with positional symptoms can be associated with difficulties in ventilation or intubation, with a risk of acute respiratory decompensation at every stage of anesthesia. CASE PRESENTATION Here we describe the anesthetic management of an 18-year-old woman with a mature teratoma who presented with progressive exertional dyspnea that was aggravated in the supine position in the operating room. After tracheal intubation, the tidal volume decreased, airway pressure increased, and pet CO2 grew beyond 105 mmHg without oxygen desaturation, prompting a femoro-femoral cardio-pulmonary bypass. CLINICAL DISCUSSION Cardio-pulmonary bypass (CPB) can facilitate tumor dissection by safely deflating the lungs and retracting the heart, enhancing exposure and reducing risks of hemodynamic or respiratory complications. However, systemic heparinization may increase complications, necessitating a preoperative risk assessment. CONCLUSION Preoperative management of large mediastinal masses requires careful attention to tumor anatomical details and relationships with surrounding structures. Preoperative preparation includes multimodality imaging and multidisciplinary team discussions to assess MMS risk, requiring specialized center management.
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Affiliation(s)
- Wissal Rouabeh
- Cardiovascular and Thoracic Surgery Department, Sahloul University Hospital, Tunisia
| | - Raoudha Chrigui
- Department of Aneasthesiology, Sahloul University Hospital, Tunisia
| | - Mgarrech Imen
- Cardiovascular and Thoracic Surgery Department, Sahloul University Hospital, Tunisia
| | - Nizar Nawwar
- Department of Aneasthesiology, Sahloul University Hospital, Tunisia
| | - Taieb Cherif
- Cardiovascular and Thoracic Surgery Department, Sahloul University Hospital, Tunisia
| | - Bechir Ben Radhia
- Cardiovascular and Thoracic Surgery Department, Sahloul University Hospital, Tunisia
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Sandeep G, Kalbande JV, Gupta A, Singha SK, Bodhey N. Anesthetic Management of Large Bronchogenic Cyst With Severe Tracheal Compression in Adults: A Case Report. Cureus 2024; 16:e62621. [PMID: 39027745 PMCID: PMC11257768 DOI: 10.7759/cureus.62621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 07/20/2024] Open
Abstract
Bronchogenic cysts (BCs) are a congenital anomaly, forming fluid-filled sacs in the bronchial tree during fetal development, and are relatively rare in adults. Patients with large BCs in the mediastinum presenting with severe tracheal compression pose a significant challenge to anesthesiologists. The confined and narrow space of the mediastinum exacerbates the compression effect on surrounding structures, leading to potential respiratory or cardiovascular collapse during anesthesia and postoperatively. Herein, we report the stepwise anesthetic management of a patient with a BC in the paratracheal region of superior mediastinum, causing near-complete tracheal compression, scheduled for right posterolateral thoracotomy and tumor excision. The patient presented with dyspnea, chest pain, cough, and severe tracheal compression necessitating meticulous airway management. Utilizing awake fiberoptic intubation with a single-lumen endotracheal tube and one-lung ventilation facilitated by an EZ bronchial blocker, we successfully secured the airway, provided ideal surgical conditions through lung deflation, and ensured perioperative safety. This case underscores the crucial role of comprehending the underlying pathophysiology, anticipating complications, and meticulously planning, preparing, and executing strategies for airway management and perioperative care in patients with mediastinal masses leading to significant tracheal compression.
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Affiliation(s)
- Gade Sandeep
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Raipur, IND
- Anesthesiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, IND
| | - Jitendra V Kalbande
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Anil Gupta
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Subrata K Singha
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Narendra Bodhey
- Radiodiagnosis, All India Institute of Medical Sciences, Raipur, Raipur, IND
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Liou DZ, Berry MF, Brown LM, Demmy TL, Huang J, Khullar OV, Padda SK, Shah RD, Taylor MD, Toker SA, Weiss E, Wightman SC, Worrell SG, Hayanga JWA. The Society of Thoracic Surgeons Expert Consensus Document on the Surgical Management of Thymomas. Ann Thorac Surg 2024:S0003-4975(24)00338-2. [PMID: 38718878 DOI: 10.1016/j.athoracsur.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Lisa M Brown
- Division of General Thoracic Surgery, Department of Surgery, UC Davis Health, Sacramento, California
| | - Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - James Huang
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Onkar V Khullar
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sukhmani K Padda
- Department Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Rachit D Shah
- Section of Thoracic and Foregut Surgery, VCU Health System, Richmond, Virginia
| | - Matthew D Taylor
- Division of Thoracic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Seyfi Alper Toker
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - Elisabeth Weiss
- Department of Radiation Oncology, VCU Health, Richmond, Virginia
| | - Sean C Wightman
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Stephanie G Worrell
- Thoracic Surgery Section, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - J W Awori Hayanga
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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7
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Ruiz de Alejos Blanco L, Brust K, Szladovits B, Drees R. Computed tomographic findings in canine and feline heart base tumors (25 cases). Vet Radiol Ultrasound 2024. [PMID: 38706413 DOI: 10.1111/vru.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 02/20/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024] Open
Abstract
Tumors located at the heart base are rare in dogs and cats and aortic body tumors (chemodectoma/paraganglioma), hemangiosarcoma, ectopic thyroid carcinoma, lymphoma, and other uncommon neoplasia can be found at that location. The objective of this retrospective case series was to describe the CT characteristics of canine and feline heart base tumors. CT studies of 21 dogs and four cats with histologically or cytologically confirmed heart base tumors were reviewed for size, location, shape, margination, contrast enhancement, adjacent neovascularization, invasion, mass effect, cavitary effusions, and metastasis. Neuroendocrine tumors (15 aortic body tumors, three ectopic thyroid carcinoma, and three nonspecific neuroendocrine) were more commonly observed than hemangiosarcoma (4) and were frequently located between the cranial vena cava and aortic arch (12/21; 57%) and or dorsal to the pulmonary trunk bifurcation/pulmonary arteries (10/21; 48%). Hemangiosarcoma was more commonly found cranioventral to the aortic arch and cranial to the right auricular appendage (3/4; 75%). Mediastinal and peritumoral neovascularization was associated with 16/21 (76%) neuroendocrine tumors but none of the hemangiosarcoma. Median postcontrast attenuation in Hounsfield units (HU) was higher in neuroendocrine (110 HU) than in hemangiosarcoma (51 HU). Pericardial effusion was frequently observed with hemangiosarcoma (3/4; 75%) and infrequently in neuroendocrine (3/21; 14%). In four cases (all neuroendocrine), concurrent cranial mediastinal masses were present. CT provides useful information regarding the characteristics of heart base tumors, indicating differences between the appearance of neuroendocrine tumors and hemangiosarcoma. However, no differences were found between aortic body tumors and ectopic thyroid carcinoma.
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Affiliation(s)
- Laura Ruiz de Alejos Blanco
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, Hertfordshire, UK
| | - Kelsey Brust
- Department of Veterinary Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Balasz Szladovits
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, University of London, Hertfordshire, UK
| | - Randi Drees
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, Hertfordshire, UK
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Yu J, Liu B, Zhou R. Extracorporeal membrane oxygenation (ECMO) assisted huge mediastinal tumor resection combined with superior vena cava replacement: A case report and literature review. Perfusion 2024:2676591241251443. [PMID: 38680106 DOI: 10.1177/02676591241251443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
As to huge solid mediastinal tumor which direct compression or invasion of the superior/inferior vena cava (SVC/IVC), surgical resection remains the main lifesaving treatment. However, it would present formidable anesthetic challenges due to the extremely high risks of cardiorespiratory compromise, drastic hemodynamic fluctuations and death at all perioperative stages. Here, we report a case of huge anterior mediastinal tumor resection combined with SVC replacement under the assistance of venoarterial extracorporeal membrane oxygenation (VA ECMO), and stable hemodynamics were maintained as well as high internal jugular vein pressure being avoided during the operation procedure. He was weaned off ECMO successfully just after surgery and eventually discharged. No signs of postoperatively neurological complications occurred. Therefore, the use of ECMO assistance in huge mediastinal tumor resection combined with SVC replacement is feasible and safe, which may provide the possibility of surgical treatment for such patients and improve outcomes.
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Affiliation(s)
- Jia Yu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, P.R. China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, P.R. China
| | - Ronghua Zhou
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, P.R. China
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9
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Huang HY, Lo CM, Lu HI, Chang JP. Huge mediastinal ancient schwannoma causing acute respiratory failure: a case report. J Cardiothorac Surg 2024; 19:131. [PMID: 38491470 PMCID: PMC10941560 DOI: 10.1186/s13019-024-02605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
Benign mediastinal tumor is usually asymptomatic and exhibits uncomplicated clinical course. Posterior mediastinal schwannoma is common, but a huge benign tumor causing acute respiratory failure due to mass effect is unusual. We present a patient who suffered from acute respiratory failure due to huge mediastinal mass effect and improved after en bloc surgical resection. A 56-year-old woman had no history of systemic disease, but experienced general discomfort and malaise for several months. She was referred to our emergency department after developing sudden respiratory failure. Intubation was performed with ventilator support and she was admitted to the intensive care unit. Chest radiograph and computed tomography showed a huge mass over the left pleural cavity causing left lung, heart, and mediastinal compression. After en bloc resection, she was weaned off the ventilator successfully and was discharged at 24 days after the operation. Postoperative outpatient follow-up showed no symptoms. Mediastinal ancient schwannoma is a rare posterior mediastinal benign tumor. However, mass effect might lead to lethal complications. En bloc resection is necessary for curative treatment.
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Affiliation(s)
- Hsuan-Ying Huang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, ROC
| | - Chien-Ming Lo
- Department of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, 123, Tapei Rd., Niaosung District, Kaohsiung City, 833, Taiwan, ROC.
| | - Hung-I Lu
- Department of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, 123, Tapei Rd., Niaosung District, Kaohsiung City, 833, Taiwan, ROC
| | - Jen-Ping Chang
- Department of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, 123, Tapei Rd., Niaosung District, Kaohsiung City, 833, Taiwan, ROC
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10
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Yan A, Ford KS, Faloye AO. Superior Vena Cava Rupture Complicated by Cardiac Tamponade. J Cardiothorac Vasc Anesth 2024; 38:788-791. [PMID: 38184382 DOI: 10.1053/j.jvca.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Amy Yan
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Emory University, Atlanta, GA
| | - Korrin Scott Ford
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Emory University, Atlanta, GA
| | - Abimbola O Faloye
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Emory University, Atlanta, GA.
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Leivaditis V, Pavlakou A, Grapatsas K, Mulita F, Koletsis E, Papatriantafyllou A, Galanis M, Katsakiori PF, Skevis K, Nikolaidis E, Dahm M, Tasios K, Tchabashvili L, Ehle B, Baltayiannis N. Challenges and pitfalls in the perioperative management of mediastinal mass syndrome: an up-to-date review. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2024; 21:47-54. [PMID: 38693982 PMCID: PMC11059013 DOI: 10.5114/kitp.2024.138581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/03/2023] [Indexed: 05/03/2024]
Abstract
The perioperative management of patients undergoing mediastinal mass operations presents a persistent challenge across multiple clinical specialties. General anesthesia administration further increases the risk of perioperative cardiorespiratory decompensation. The interdisciplinary team plays a crucial role in ensuring a safe perioperative period. However, due to the rarity and variability of mediastinal mass syndromes, specific management protocols are lacking. This review aims to outline the multitude of challenges and pitfalls encountered during perioperative management in patients with the mediastinal mass syndrome. We describe diagnostic evaluation, preoperative optimization, intraoperative considerations, and postoperative care strategies, emphasizing the paramount significance of a multidisciplinary approach and personalized treatment plans. Preoperative multidisciplinary discussions, meticulous anesthetic management, and well-established protocols for emergency situations are pivotal to ensuring patient safety. Healthcare providers involved in the care of patients with mediastinal mass syndrome must grasp these challenges and pitfalls, enabling them to deliver safe and effective perioperative management.
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Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | - Afroditi Pavlakou
- Department of Anesthesiology, Metaxa Cancer Hospital, Piraeus, Greece
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen – Ruhrland Clinic, Essen, Germany
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
| | | | - Michail Galanis
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Levan Tchabashvili
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Benjamin Ehle
- Department of Thoracic Surgery, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
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12
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Tani K, Kimura D, Matsuo T, Sasaki T, Kimura S, Muto C, Minakawa M. Perioperative strategies and management of giant anterior mediastinal tumors: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2024; 8:34. [PMID: 38881815 PMCID: PMC11176986 DOI: 10.21037/med-23-40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/10/2023] [Indexed: 06/18/2024]
Abstract
Background and Objective Giant anterior mediastinal tumors sometimes may cause circulatory collapse and respiratory failure, known as mediastinal mass syndrome (MMS). The prediction and prevention of MMS is challenging. The aim of this study is to summarize the evaluation methods for MMS and formulate treatment strategies for giant anterior mediastinal tumors. Methods We performed a thorough analysis of recent international literature on giant anterior mediastinal tumors (>10 cm in diameter) and MMS published in the PubMed database. The search spanned the duration of the preceding 10 years from August 19, 2023, and only studies published in English were included. Key Content and Findings Mature teratomas and liposarcomas are the most common giant anterior mediastinal tumors and MMS develops most frequently in case of malignant lymphomas. Here, we propose a new treatment strategy for giant anterior mediastinal tumors. Based on imaging findings, giant anterior mediastinal tumors can be classified as cystic or solid and further blood investigation data are useful for a definitive diagnosis. When malignant lymphoma or malignant germ cell tumor is highly suspected, the first choice of treatment is not surgery but chemotherapy and radiotherapy. Moreover, image-guided drainage may be effective if giant cystic anterior tumors develop into MMS. The risk classification of MMS is important for treating giant anterior mediastinal tumors. If the MMS risk classification is 'unsafe' or 'uncertain', the intraoperative management deserves special attention. The surgical approach should however be based on tumor localization and invasion of surrounding tissues. Multidisciplinary team coordination is indispensable in the treatment of giant anterior mediastinal tumors. Conclusions When giant anterior mediastinal tumors are encountered, it is important to follow the appropriate treatment strategy, focusing on the development of MMS based on imaging findings and symptoms.
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Affiliation(s)
- Kengo Tani
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Daisuke Kimura
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Tsubasa Matsuo
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Takahiro Sasaki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Shuta Kimura
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Chisaki Muto
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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13
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Gahagen RE, Gaylord WC, Drayton Jackson MD, McCallister AE, Lutfi R, Belsky JA. Implementation of an Anterior Mediastinal Mass Pathway to Improve Time to Biopsy and Multidisciplinary Communication. Pediatr Qual Saf 2024; 9:e715. [PMID: 38322297 PMCID: PMC10843474 DOI: 10.1097/pq9.0000000000000715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
Background Mediastinal masses in children with cancer present unique challenges, including the risk of respiratory and hemodynamic compromise due to the complex anatomy of the mediastinum. Multidisciplinary communication is often a challenge in the management of these patients. After a series of patients with mediastinal masses were admitted to Riley Hospital for Children Pediatric Intensive Care Unit, the time from presentation to biopsy and pathology was greater than expected. We aimed to reduce the time to biopsy by 25% and demonstrate improved multidisciplinary communication within 6 months of protocol implementation for patients presenting to Riley Hospital for Children Emergency Department with an anterior mediastinal mass. Methods Quality improvement methodology created a pathway that included early multidisciplinary communication. The pathway includes communication between the emergency department and multiple surgical and medical teams via a HIPPA-compliant texting platform. Based on patient stability, imaging findings, and sedation risks, the approach and timing of the biopsy were determined. Results The pathway has been used 20 times to date. We successfully reduced the time to biopsy by 38%, from 25.1 hours to 15.4 hours. There was no statistically significant reduction in time to pathology. The multidisciplinary team reported improved communication from a baseline Likert score of 3.24 to 4. Conclusions By initiating early multidisciplinary communication, we reduced the time to biopsy and pathology results, improving care for our patients presenting with anterior mediastinal masses.
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Affiliation(s)
- Rachel E. Gahagen
- From the Division of Pediatric Critical Care Riley Hospital for Children
- Department of Pediatrics, Indiana University School of Medicine
| | - William C. Gaylord
- From the Division of Pediatric Critical Care Riley Hospital for Children
- Division of Pediatric Hematology-Oncology Riley Hospital for Children
| | - Meghan D. Drayton Jackson
- From the Division of Pediatric Critical Care Riley Hospital for Children
- Division of Pediatric Hematology-Oncology Riley Hospital for Children
| | | | - Riad Lutfi
- From the Division of Pediatric Critical Care Riley Hospital for Children
- Department of Pediatrics, Indiana University School of Medicine
| | - Jennifer A. Belsky
- From the Division of Pediatric Critical Care Riley Hospital for Children
- Division of Pediatric Hematology-Oncology Riley Hospital for Children
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14
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Mardani P, Kamran H, Ghaderpanah R, Geramizadeh B, Fouladi D, Shahriarirad R, Amirian A. A massive immature mediastinal teratoma treated with chemotherapy and surgical resection: a case report. J Cardiothorac Surg 2023; 18:294. [PMID: 37845684 PMCID: PMC10580578 DOI: 10.1186/s13019-023-02389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 09/30/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Teratoma is a type of germ cell tumor consisting of one or multiple tissues derived from germinal layers. The location and size of the tumor can cause various presentations. Here we report one of the largest ever cases of immature cystic teratoma. CASE PRESENTATION In this report, we presented a 24-year-old patient with dyspnea, chest pain, nausea, and anorexia. A computed tomography scan revealed a giant, right-sided mass measuring about 190 × 150 × 140 mm. Chemotherapy was initiated for the patient, followed by thoracotomy. Histopathological evaluation revealed the nature of the mass to be an immature mediastinal teratoma. CONCLUSION the incidence of immature mediastinal teratoma is uncommon, and due to its rarity, the diagnosis needs more profound evaluation studies such as radiological and pathological assessments. Immature teratomas are optimally treated by a combination of chemotherapy and complete resection.
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Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rezvan Ghaderpanah
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- Shiraz Transplant Research Center (STRC), Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Damoun Fouladi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
- Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Armin Amirian
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
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15
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Wherley EM, Gross DJ, Nguyen DM. Extracorporeal membrane oxygenation in the surgical management of large mediastinal masses: a narrative review. J Thorac Dis 2023; 15:5248-5255. [PMID: 37868893 PMCID: PMC10586946 DOI: 10.21037/jtd-22-1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 07/14/2023] [Indexed: 10/24/2023]
Abstract
Background and Objective The management of large mediastinal tumors requires a complex multidisciplinary approach, particularly in the perioperative setting due to increased risk of hemodynamic compromise. The utilization of extracorporeal membrane oxygenation (ECMO) provides a useful adjunct in the surgical management for biopsy and resection of these mediastinal masses. The objective of this article is to review indications and implementation of ECMO in the surgical management of mediastinal disease. Methods A literature review of the PubMed database was completed evaluating articles discussing 'extracorporeal circulation', 'cardiopulmonary bypass', 'anesthesia', 'mediastinal disease', and 'mediastinal cancer'. These articles were evaluated for contribution to the discussion of indications and implementation of ECMO in the management of these patients. Key Content and Findings Large mediastinal tumors place patients at risk of hemodynamic collapse on induction of anesthesia due to compression of vascular structures, tracheobronchial tree and creation of V/Q mismatch. Patients may be stratified regarding their risk of perioperative complications by evaluation of postural symptoms, cross sectional imaging findings and pulmonary function tests. Those patients at elevated perioperative risk may benefit from the utilization of ECMO, most commonly veno-arterial (V-A) ECMO. Guidewires or ECMO cannulas may be placed under local anesthesia prior to induction. Those patients with hemodynamic compromise may receive mechanical circulatory support to allow completion of the operation. Conclusions The use of a multidisciplinary team consisting of surgeons, anesthesiologists, perfusionists and OR team is critical to the success in the use of ECMO in the resection of mediastinal masses. With diligent preparation, these high-risk patients may be optimally managed at the time of resection.
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Affiliation(s)
- Eric M Wherley
- Section of Thoracic Surgery, Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
| | - Daniel J Gross
- Section of Thoracic Surgery, Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
| | - Dao M Nguyen
- Section of Thoracic Surgery, Division of Cardiothoracic Surgery, The DeWitt Daughtry Department of Surgery, University of Miami, Miami, FL, USA
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16
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Rochefort MM. Size should not be an absolute contraindication: the case for robotic resection of ever larger anterior mediastinal masses. MEDIASTINUM (HONG KONG, CHINA) 2023; 7:23. [PMID: 37701640 PMCID: PMC10493616 DOI: 10.21037/med-23-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
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17
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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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18
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Bendre PS, Banerjee A, Munghate G, Karkera PJ, Bodhanwala M. Application of the Clamshell Thoracotomy in an Infant with a Large Mediastinal Tumor. J Indian Assoc Pediatr Surg 2023; 28:170-172. [PMID: 37197234 PMCID: PMC10185027 DOI: 10.4103/jiaps.jiaps_91_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/22/2022] [Accepted: 11/20/2022] [Indexed: 05/19/2023] Open
Abstract
Historically it was recommended for emergency thoracotomy in thoracic trauma as the last resort when there was cardiopulmonary arrest. Nowadays, the only indications are lung transplantation and huge mediastinal masses. We report the use of a clamshell thoracotomy in a 7-month-old boy with a large anterior mediastinal mass extending into the bilateral thoracic cavities.
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Affiliation(s)
- Pradnya S Bendre
- Department of Pediatric Surgery, B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Arka Banerjee
- Department of Pediatric Surgery, B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Gayatri Munghate
- Department of Pediatric Surgery, B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Parag Janardhan Karkera
- Department of Pediatric Surgery, B J Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Minnie Bodhanwala
- Department of Pediatric Surgery, B J Wadia Hospital for Children, Mumbai, Maharashtra, India
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19
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Yue J, Zhou L, Liang P. A case of unexpected intraoperative airway obstruction in a patient with an aneurysm of the ascending aorta and aortic arch. Anaesth Intensive Care 2023; 51:72-74. [PMID: 36217292 DOI: 10.1177/0310057x221076139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Upper airway compression is one of the clinical manifestations of thoracic aortic aneurysm, which is associated with poor prognosis and high mortality. A 44-year-old patient with ascending aortic and arch aneurysm who was scheduled for Bentall surgery and total arch replacement under cardiopulmonary bypass suffered difficult ventilation after endotracheal intubation. The patient did not exhibit any positional dyspnoea or orthopnoea, did not show any difficulties in the supine position, and had no noteworthy medical history. However, we encountered unexpected hypoventilation after intubation. Isoprenaline infusion was effective while emergency cardiopulmonary bypass was established to deal with this crisis. Fibreoptic bronchoscopy revealed complete obstruction of the carina and confirmed the supracarinal position of the tube. Complete airway obstruction may occur even if there are no symptoms before surgery in patients with thoracic aortic aneurysm. Comprehensive preoperative assessment, a well-developed airway management plan, and responses to possible emergencies are essential to reduce unnecessary events or complications.
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Affiliation(s)
- Jianming Yue
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Leng Zhou
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Peng Liang
- Day Surgery Center, West China Hospital of Sichuan University, Chengdu, China
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20
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Rodriguez M, Milla L, Wee JO. The role of minimally invasive surgery in the management of giant mediastinal tumors: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2022; 6:37. [PMID: 36582972 PMCID: PMC9792823 DOI: 10.21037/med-21-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 04/11/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Beyond diagnosis, minimally invasive surgery has traditionally not been considered suitable for large tumors, those invading vital structures or high-risk patients. However, with the improvement of multimodality treatments able to reduce tumor size preoperatively, patient evaluation and selection, perioperative care (including both surgical and anesthesiological techniques) and postoperative management, the indications of minimally invasive surgery, even in giant mediastinal tumors, have increased and will continue to broaden in future years. This review aims to summarize the existing literature regarding the role of minimally invasive surgery in the management of giant mediastinal tumors. We have focused in the role minimally invasive surgery has in diagnosis and treatment of these tumors and we have tried to provide an updated perspective to identify future applications and work-directions. METHODS Data regarding minimally invasive surgery in giant mediastinal tumors are limited, including a proper definition of them. We performed a PubMed search of English and Spanish written studies until August 2021. KEY CONTENT AND FINDINGS There is limited data related to minimally invasive surgery in giant mediastinal tumors and much of the literature review we have performed has yielded isolated case reports, case series with a low number of cases or editorials. Although the role of minimally invasive surgery is well consolidated as a diagnostic approach, adequate patient selection, hospital volume and experience, multidisciplinary discussion of candidates, patient safety and adequate oncological resection remain the most important aspects to be taken into account when considering a minimally invasive approach for a giant mediastinal tumor. CONCLUSIONS With careful and multidisciplinary perioperative planning, minimally invasive surgery has shown to be safe and to provide at least similar outcomes when compared to open approaches in well selected cases. Although data is still limited, improved surgical techniques and available technology will pave the way to increased indications of minimally invasive surgery in giant mediastinal tumors.
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Affiliation(s)
- Maria Rodriguez
- Department of Thoracic Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - Lucia Milla
- Department of Thoracic Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - Jon O. Wee
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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21
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Sicolo E, Aprile V, Ferrarello T, Bacchin D, Mastromarino MG, Alì G, Ambrogi MC, Lucchi M, Korasidis S. An asymptomatic giant AB thymoma in a patient with Down syndrome: a case report. MEDIASTINUM (HONG KONG, CHINA) 2022; 6:39. [PMID: 36582979 PMCID: PMC9792865 DOI: 10.21037/med-22-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/17/2022] [Indexed: 01/01/2023]
Abstract
Background Mediastinal mass management may represent a real challenge for all the physicians who deal with it. Mediastinum, in fact, contains different vital structures which are often involved by growing neoplasms with increasing severity. Therefore, up to 60% of the patients with mediastinal mass are symptomatic, according to the structure involved. Different neoplasms may arise essentially from all mediastinal organs, whereas thymic epithelial tumors and lymphomas represent more than 90% of mediastinal tumors. Case Description We report the first case described of a giant asymptomatic mediastinal mass in a 43-year-old male affected by Down syndrome (DS), turned out to be a thymoma, treated exclusively and successfully with radical surgery. Despite the absence of any symptoms, the giant thymoma infiltrated the diaphragm, the pericardium, the upper lobe of the left lung together with the left phrenic nerve resulting in the compression of heart and great vessels. Conclusions To date, this is the first description of a thymic malignancy in a patient with DS, that usually is characterized by a low-incidence of solid tumor except for germ-cells ones. Surgery has been extremely challenging, due the clinical condition of the patient together with the tumor features; nevertheless, oncological radicality criteria were completely fulfilled. After four years from surgery, the patient is alive and still disease-free, highlighting the importance of radical surgery.
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Affiliation(s)
- Elisa Sicolo
- Thoracis Surgery Division, Cardiac-Vascular and Thoracic Department, University Hospital of Pisa, Pisa, Italy
| | - Vittorio Aprile
- Thoracis Surgery Division, Cardiac-Vascular and Thoracic Department, University Hospital of Pisa, Pisa, Italy
| | - Tommaso Ferrarello
- Thoracis Surgery Division, Cardiac-Vascular and Thoracic Department, University Hospital of Pisa, Pisa, Italy
| | - Diana Bacchin
- Thoracis Surgery Division, Cardiac-Vascular and Thoracic Department, University Hospital of Pisa, Pisa, Italy
| | - Maria Giovanna Mastromarino
- Thoracis Surgery Division, Cardiac-Vascular and Thoracic Department, University Hospital of Pisa, Pisa, Italy
| | - Greta Alì
- Unit of Pathological Anatomy, University Hospital of Pisa, Pisa, Italy
| | - Marcello Carlo Ambrogi
- Thoracis Surgery Division, Cardiac-Vascular and Thoracic Department, University Hospital of Pisa, Pisa, Italy
| | - Marco Lucchi
- Thoracis Surgery Division, Cardiac-Vascular and Thoracic Department, University Hospital of Pisa, Pisa, Italy
| | - Stylianos Korasidis
- Thoracis Surgery Division, Cardiac-Vascular and Thoracic Department, University Hospital of Pisa, Pisa, Italy
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22
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Tan JC, Lin PS, He LX, Lin Y, Yao YT. Anesthetic management of patients undergoing mediastinal mass operation. Front Surg 2022; 9:1033349. [PMID: 36386507 PMCID: PMC9649874 DOI: 10.3389/fsurg.2022.1033349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives To summarize the anesthetic management of patients undergoing mediastinal mass operation. Methods Electronic databases were searched to identify all case reports of patients undergoing mediastinal mass operation. Information such as clinical characteristics, perioperative management and patients’ outcomes were abstracted and analyzed. Results Seventy-seven case reports with 85 patients aging from 34 days to 81 years were included. Mediastinal masses were located in anterior (n = 48), superior (n = 15), middle (n = 9) and posterior (n = 9) mediastinum, respectively. Clinical manifestations included dyspnea (n = 45), cough (n = 29), chest or radiating pain (n = 12), swelling (n = 8), fever (n = 7) and chest distress (n = 4). Most patients (n = 75) had signs of compression or invasion of vital structures. General anesthesia (n = 76) was the most commonly used method of anesthesia. Muscle relaxants were administered in 35 patients during anesthesia induction and spontaneous respiration was maintained in 37 patients. Mediastinal mass syndrome (MMS) occurred in 39 cases. Extracorporeal circulation was utilized in 20 patients intraoperatively. Three patients experienced cardiac arrest after ventilation failure and two patients died intraoperatively and one postoperatively. Conclusions Peri-operative management of patients undergoing mediastinal mass operation could be challenging. Pre-operative multi-disciplinary discussion, well-planned anesthetic management and pre-determined protocols for emergency situations are all vital to patient safety.
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Affiliation(s)
- Jie-chao Tan
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Anesthesiology, Shunde Hospital of South Medical University, Foshan, China
| | - Pei-shuang Lin
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Anesthesiology, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China
| | - Li-xian He
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Anesthesiology, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Yong Lin
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yun-tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Correspondence: Yun-tai Yao
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23
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Daly H, Horchani A. Mature teratoma of the anterior mediastinum revealed by supravalvular pulmonary stenosis: a case report. Pan Afr Med J 2022; 43:109. [PMID: 36699971 PMCID: PMC9834795 DOI: 10.11604/pamj.2022.43.109.32333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 10/01/2022] [Indexed: 11/06/2022] Open
Abstract
The mature teratoma of the mediastinum is a benign tumour made up of several adult-type tissue components which result from the abnormal development of two or three embryonic layers (ectoderm, endoderm or mesoderm). We report the case of a 31-year-old patient, admitted for management of a mediastinal tumour, revealed by a pulmonary supravalvular stenosis, symptomatic of exertional dyspnea and mid-thoracic pain. The clinical examination objectified a respiratory rate at 18 c/min and an oxygen saturation at 96% in ambient air. The chest X-ray showed a mediastinal enlargement with a left paracardiac opacity, while the echocardiac showed a supravalvular pulmonary stenosis, hence the realization of a thoracic computed tomography (CT), which objectified a voluminous anterior mediastinal cystic formation and superior lateralized on the left, with an effect of compression on the trunk of the pulmonary artery. The median sternotomy allowed the complete exeresis of this tumor and the postoperative course was simple. The mature teratoma of the anterior mediastinum should be suspected in view of these clinical and radiological signs in a young patient. Surgery with a complete resection remains the treatment of choice.
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Affiliation(s)
- Hafedh Daly
- Faculty of Medicine, Cardiovascular Surgery Department, Monastir, Tunisia,,Corresponding author: Hafedh Daly, Faculty of Medicine, Cardiovascular Surgery Department, Monastir, Tunisia.
| | - Amira Horchani
- Faculty of Medicine, Pharmacy Department, Monastir, Tunisia
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24
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Zhang Z, Jiang M, Sun X, Tan W. Case report: Reducing the duration of positive-pressure ventilation for large mediastinal masses. Front Cardiovasc Med 2022; 9:947847. [PMID: 36017089 PMCID: PMC9395709 DOI: 10.3389/fcvm.2022.947847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
Large mediastinal masses (MMs) are rare and present some challenges in hemodynamic and airway management under general anesthesia. Multiple studies have reported cardiopulmonary collapse during general anesthesia. Maintenance of spontaneous ventilation, avoidance of muscle relaxants, and awake-intubation were usually recommended during general anesthesia for high-risk patients with large MMs. However, the recent notion challenged the classic teaching that maintaining spontaneous ventilation is superior to positive-pressure ventilation (PPV). In our case reports, we present two patients with large MMs during general anesthesia. In the first case, a 21-year-old male was administered a muscle relaxant during induction, followed by PPV, but his blood oxygen saturation decreased to 40% after 20 min. Finally, his oxygen saturation was restored by a sternotomy rather than by cardiopulmonary bypass (CPB) by femoral vascular intubation. In the second case, a 33-year-old male was also administered a muscle relaxant during induction followed by PPV, but for him, sternotomy was immediately performed, with stable blood oxygen saturation. Both patients recovered well and were discharged from hospital a week after surgery. Therefore, we present a recommendation that patients with large MMs could undergo PPV after the administration of a muscle relaxant during induction, but the cardiothoracic surgeon should immediately cleave the sternum.
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25
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Adi O, Fong CP, Ahmad AH, Panebianco N. Worsening cardiac tamponade after pericardiocentesis in a patient with anterior mediastinum mass: a case report. Eur Heart J Case Rep 2022; 6:ytac329. [PMID: 36004046 PMCID: PMC9395134 DOI: 10.1093/ehjcr/ytac329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/25/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022]
Abstract
Background Mediastinal mass is an entity with variable pathology and clinical spectrum. Anterior mediastinal mass can result in severe symptoms due to involvement of surrounding vital structures such as the great vessels, trachea-bronchial tree, and heart. We highlight a case of cardiac tamponade in a patient with an anterior mediastinal mass that was paradoxically worsened after decompressive pericardiocentesis. Case summary A 21-year-old male presented to the emergency department (ED) with breathlessness and hypotension. Bedside focused cardiac ultrasound revealed cardiac tamponade which was made worse with an anterior mediastinal mass compressing the right heart chambers. The patient was intubated for respiratory failure, following which an ultrasound-guided pericardiocentesis was performed. Unexpectedly, his hemodynamic status worsened after aspiration of 1000 mL of pericardial fluid. A repeat focused cardiac ultrasound showed reduced pericardial effusion, but worsening of right heart chambers compression by the mediastinal mass. Re-expansion of the pericardium space with 600 mL of normal saline improved the patient’s vital signs, and reduced the right heart compression. Computed tomography was deferred due to the patient’s hemodynamic instability. Despite resuscitation with fluids and initiation of vasopressor, the patient’s condition deteriorated. He succumbed to his illness due to obstructive shock causing multi-organ failure. The autopsy showed a large anterior mediastinal mass, and histopathological examination confirmed the diagnosis of lymphoma. Discussion This case demonstrated the therapeutic challenges of managing a shock patient with anterior mediastinal mass, and massive pericardial effusion causing cardiac tamponade.
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Affiliation(s)
- Osman Adi
- Department, Hospital Raja Permaisuri Bainun , Ipoh, PRK , Malaysia
| | - Chan Pei Fong
- Department, Hospital Raja Permaisuri Bainun , Ipoh, PRK , Malaysia
| | | | - Nova Panebianco
- Department of Emergency Medicine, Hospital of the University of Pennsylvania , Philadelphia, PA , USA
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Gondar MB, Fernandes M, Mondragon P, Hagerman A, Magnusson L. Intercostal nerve block is effective in open biopsies of the anterior mediastinal region: Case report and review. Int J Surg Case Rep 2022; 97:107461. [PMID: 35907298 PMCID: PMC9403297 DOI: 10.1016/j.ijscr.2022.107461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Anterior mediastinal masses are rare conditions that can become symptomatic through compression of the airways and vascular structures. Fatal or severe complications can occur during anesthesia and surgery. With this review we aim to describe the state of the art in peri-anesthetic management of mediastinal tumors, which we illustrate with a clinical case. PRESENTATION OF CASE We report a case of a young female patient suffering from a large anterior mediastinal mass that underwent an open biopsy after intercostal nerve blocks (INB) in six consecutive right intercostal spaces (2nd to 7th). A right anterior mediastinotomy was performed and an excellent analgesic effect was achieved. The patient was awake and did not experience significant pain or cough, having received paracetamol 1 g and returned home later in the day. The diagnosis of non-Hodgkin's lymphoma was later confirmed. DISCUSSION Our review showed that anesthesia for mediastinal masses' resection or open biopsy is rare and prone to severe complications. Such complications are more important in children, patients in supine position, under general anesthesia and already symptomatic prior to the procedure. INB presents some advantages against paravertebral block (PVB) and thoracic epidural anesthesia (TEA), is easier to reproduce and has a shorter learning curve. Airway stenting with a rigid bronchoscope can be an alternative. CONCLUSION Multilevel medial axillary line INBs are safer and easier to reproduce than PVB, have less hemodynamic repercussion than TEA and can, therefore, be preferable for open anterior mediastinal biopsies or small masses resection.
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Affiliation(s)
- Marina Brito Gondar
- Department of Anesthesiology, Hôpital Fribourgeois, Fribourg, Switzerland,Département de Médecine Aiguë, Service d'Anesthésiologie, Hôpitaux Universitaires de Genève, Genève, Switzerland,Corresponding author at: Department of Anesthesiology, Hôpital fribourgeois, Chemin des Pensionnats 2-6, 1752 Villars-sur-Glâne, Switzerland.
| | - Mariana Fernandes
- Department of Anesthesiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | - Pablo Mondragon
- Department of Anesthesiology, Hôpital Fribourgeois, Fribourg, Switzerland,Faculty of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Andres Hagerman
- Département de Médecine Aiguë, Service d'Anesthésiologie, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Lennart Magnusson
- Department of Anesthesiology, Hôpital Fribourgeois, Fribourg, Switzerland,Faculty of Medicine, University of Fribourg, Fribourg, Switzerland
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Reexpansion Pulmonary Edema following Tube Thoracostomy in a Pediatric Patient with Anterior Mediastinal Mass. Case Rep Anesthesiol 2022; 2022:8547611. [PMID: 35646401 PMCID: PMC9135562 DOI: 10.1155/2022/8547611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 11/20/2022] Open
Abstract
Reexpansion pulmonary edema (RPE) is an exceedingly rare and potentially fatal complication of a rapidly reexpanded lung following evacuation of air or fluid from the pleural space secondary to conditions such as a mediastinal mass, pleural effusion, or pneumothorax. Clinical presentations can range from mild radiographic changes to acute respiratory failure and hemodynamic instability. The rapidly progressive nature of the disease makes it important for clinicians to appropriately diagnose and manage patients who develop RPE. We present a case of a child with a large malignant pleural effusion who developed severe RPE after tube thoracostomy and ultimately required venoarterial extracorporeal membrane oxygenation (VA-ECMO). The patient was 7-year-old Caucasian male with newly diagnosed ambiguous T cell myeloid leukemia. A chest computerized tomography (CT) demonstrated a large pleural effusion causing tracheal shift and left bronchus compression as well as an anterior mediastinal mass causing compression of the right atria and right ventricle. Tube thoracostomy was performed in the operating room (OR) with deep sedation. The procedure was complicated with hypoxemia, bradycardia, and pulseless cardiac arrest. After return of spontaneous circulation, the child continued to have refractory hypoxemia, profound hypotension, and frothy secretions. Endotracheal intubation was performed with a size 5.0 cuffed endotracheal tube. Chest radiograph demonstrated opacification of the left hemithorax with chest infiltrates. Patient required VA-ECMO for circulatory support. Supportive therapy of RPE was continued and decannulation was done on day three. Tracheal extubation was performed on day five.
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Leung KKY, Ku SW, Hon KL, Chigaru L, Chiang AKS, Kan EYL, Oberender F. Recommendations on the Management of Interhospital Transport of Pediatric Patients With Mediastinal Mass. Pediatr Emerg Care 2022; 38:e1104-e1111. [PMID: 34417789 DOI: 10.1097/pec.0000000000002517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Children with mediastinal masses often present with insidious symptoms to nonspecialist centers and require interhospital transport to oncology centers for definitive care. We evaluated clinical characteristics and patient outcomes and proposed a management protocol. MATERIALS AND METHODS This is a retrospective review of all children with mediastinal mass at the pediatric intensive care unit of the Hong Kong Children's Hospital between April 2019 and March 2020. RESULTS Ten children with a median age of 14.5 years (interquartile range, 9.3-17.0 years) were included. Leukemia and lymphoma accounted for the majority of cases (n = 6, 60%). Nearly all patients (n = 9, 90%) required interhospital transport before definitive treatment could be instituted. There were no deaths, but 2 patients were transported with significant respiratory compromise. Among patients requiring more than 1 interhospital transport, there was a higher incidence of shortness of breath (100% vs 40%; odds ratio, 33; P = 0.048) and orthopnea (80% vs 0%; odds ratio, 33; P = 0.048), whereas none had a neck mass (0% vs 80%; odds ratio, 0.03; P = 0.048). CONCLUSIONS Children with mediastinal mass are at risk of life-threatening cardiorespiratory compromise. Pretransport assessment, planning, and stabilization along with clear management plans for deterioration during transport are crucial especially for patients who are symptomatic at time of presentation, to reduce risks associated with delays in arriving at the specialist point of care for definitive treatment.
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Affiliation(s)
- Karen Ka Yan Leung
- From the Paediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
| | - Shu Wing Ku
- From the Paediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
| | - Kam Lun Hon
- From the Paediatric Intensive Care Unit, Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
| | - Linda Chigaru
- Children's Acute Transport Service and Paediatric Anaesthesia, Great Ormond Street Hospital, London, United Kingdom
| | | | - Elaine Y L Kan
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong
| | - Felix Oberender
- Paediatric Intensive Care Unit, Monash Children's Hospital Melbourne, Clayton, Australia
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Chen L, Zhu X, Zhu R, Jin X, Tan L, Chen Y. Cardiopulmonary bypass does not consequentially contribute to postoperative distant metastasis of giant refractory thoracic tumors: A retrospective study with long-term follow-up. Thorac Cancer 2021; 12:2990-2995. [PMID: 34532966 PMCID: PMC8590891 DOI: 10.1111/1759-7714.14162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/03/2021] [Accepted: 09/04/2021] [Indexed: 12/01/2022] Open
Abstract
Background Few clinical research studies with long‐term follow‐up have revealed whether cardiopulmonary bypass (CPB) increases the risk of postoperative distant metastasis in patients with giant refractory thoracic tumors. The present study evaluated the risk of distant metastasis after surgery utilizing CPB with long‐term follow‐up. Methods Clinical data for patients with giant refractory thoracic tumors who underwent resection with the use of CPB in the Second Affiliated Hospital of Soochow University during the past 11 years were retrospectively reviewed. Results Of the 14 patients with giant refractory thoracic tumors who had undergone surgery under CPB, 10 patients (71.4%) were completely resected. Twelve patients were followed up for 13–127 months with 10 patients were completely resected and two patients could not be completely resected due to severe tissue invasion. Three patients (25%) suffered from distant metastasis, and four patients (33.3%) experienced local recurrence. Only one patient (1/10) with complete resection suffered from distant metastasis, while two patients (2/10) experienced local recurrence. Two patients (2/2) with major resection suffered from both distant metastasis and local recurrence. Median overall survival for patients who have been regularly followed up was 50 months with 1‐, 5‐, and 10‐year survival of 100%, 75%, and 66.7%. No difference was found between the distant metastasis survival and the local recurrence survival. (p = 0.99). Conclusions CPB is an effective strategy for complete resection of the giant refractory thoracic tumors with an acceptable risk of postoperative distant metastasis for some patients.
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Affiliation(s)
- Lei Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuejuan Zhu
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rongying Zhu
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xing Jin
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Liping Tan
- Department of Nursing, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongbing Chen
- Department of Thoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou, China
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Holmes C, Loo PS, Barnard S. Primary mediastinal seminoma with florid follicular lymphoid hyperplasia: a case report and review of the literature. Diagn Pathol 2021; 16:76. [PMID: 34419077 PMCID: PMC8380391 DOI: 10.1186/s13000-021-01137-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/11/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND First described in 1955 Primary mediastinal seminomas are rare. Only 1-4% of mediastinal tumours are germ cell tumors; majority of which are teratomas. They typically present in men aged between 20 and 40 years. Very few cases are reported in the literature. Florid follicular lymphoid hyperplasia can obscure the malignant cells and is a rarer finding still. We present a rare case of a 48 year old man with a primary mediastinal seminoma with florid follicular lymphoid hyperplasia; found following excision of a clinically presumed thymoma. CASE PRESENTATION A 48 year old man was referred for excision of a thymic mass. The presumed diagnosis was a thymoma; following preoperative investigations. The mass was incidentally found on a radiological imaging. However, the patient did report mid-sternal discomfort on lying flat and breathlessness. The patient underwent a thymectomy via a partial median sternotomy with good recovery. Histological assessment was that the mass was in fact a primary mediastinal seminoma with florid follicular lymphoid hyperplasia. A primary testicular malignancy was excluded and the patient required no further oncological treatment. CONCLUSIONS Only 11 cases have previously been reported of primary mediastinal seminoma with florid follicular lymphoid hyperplasia. Although rare, a primary mediastinal seminoma should be considered as a differential diagnosis for presentations with a thymic mass. Tumour markers can be helpful, however are only positive in third of cases. Ultrasound imaging of the gonads is essential to exclude a primary gonadal lesion. Pure seminomas are radiotherapy and chemotherapy sensitive however the mainstay treatment of primary mediastinal seminomas remains surgical excision. Radiotherapy is reserved postoperatively for incomplete surgical margins.
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Cascone R, Carlucci A, Messina G, Noro A, Bove M, Natale G, Sagnelli C, Opromolla G, Martone M, Santoriello C, Santoriello E, Verolino P, Creta M, Vicidomini G, Fiorelli A, Santini M, Sica A. Ultrasound-Guided Anterior Mediastinotomy: A Feasible Tool for Critical Lymphoma Patients. Healthcare (Basel) 2021; 9:healthcare9060770. [PMID: 34205526 PMCID: PMC8235016 DOI: 10.3390/healthcare9060770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/20/2022] Open
Abstract
A significant part of all neoplasms growing in anterior mediastinum are lymphomas (25%). Achieving a correct diagnosis and a clear definition of a lymphoma’s subtype is crucial for beginning chemotherapy as soon as possible. However, most patients present a large mediastinal mass that compresses vessels and airway, with serious cardiorespiratory repercussions. Therefore, having multiple tools available to biopsy the lesion without worsening morbidity becomes fundamental. Patients enrolled in this study were unfit for a surgical biopsy in general anesthesia and the need to begin chemotherapy as fast as possible prompted us to avoid percutaneous fine needle aspiration to prevent diagnostic failures. Our observational study included 13 consecutive patients with radiological findings of anterior mediastinal mass. Ultrasonography was performed directly in the theatre to mark the lesion and to localize vessels and vascularized neoplastic tissue. Open biopsy was carried out in spontaneous breathing with a laryngeal mask and with short-acting medications for a rapid anesthesia, performing an anterior mediastinotomy. The mean operative time was 33.4 ± 6.2 min and spontaneous respiration was maintained throughout the procedure. No complications were reported. All patients were discharged in the first or second postoperative day after a chest X-ray (1.38 ± 0.5 days). The diagnostic yield of this approach was 100%. With the addition of ultrasonography right before the procedure and with spontaneous breathing, anterior mediastinotomy still represents a useful tool in critical patients that could hardly tolerate a general anesthesia. The diagnostic yield is high, and the low postoperative morbidity allows a rapid onset of chemotherapy.
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Affiliation(s)
- Roberto Cascone
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Annalisa Carlucci
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Gaetana Messina
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Antonio Noro
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Mary Bove
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Giovanni Natale
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-33938107860 or +39-08119573375
| | - Giorgia Opromolla
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Mario Martone
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Carlo Santoriello
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Elena Santoriello
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Pasquale Verolino
- Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Luigi Vanvitelli University of Campania, 80131 Naples, Italy;
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Giovanni Vicidomini
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Mario Santini
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (R.C.); (A.C.); (G.M.); (A.N.); (M.B.); (G.N.); (G.O.); (M.M.); (C.S.); (E.S.); (G.V.); (A.F.); (M.S.)
| | - Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy;
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Svitek V, Dzian A, Mičák J. Superior vena cava replacement for epithelioid haemangioendothelioma. Interact Cardiovasc Thorac Surg 2021; 33:668-670. [PMID: 33948629 DOI: 10.1093/icvts/ivab136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 11/12/2022] Open
Abstract
Epitheloid haemangiothelioma is extremely rare malignant tumour of vascular origin. Mediastinal location of this neoplasm with large veins involving is not common. We report a case of epitheloid haemangiothelioma in superior vena cava treated by radical resection and superior vena cava replacement with polytetrafluoroethylene prosthetic graft. There is a certain risk of neurological injury during the cross-clamping of superior vena cava in patient with incompletely obstructed veins. Venovenous shunt is a useful surgical strategy in this type of lesion without necessity of cardiopulmonary bypass use.
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Affiliation(s)
- Vladimir Svitek
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia.,Department of Cardiac Surgery, Central Slovak Institute for Cardiovascular Diseases, Banská Bystrica, Slovakia
| | - Anton Dzian
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Jozef Mičák
- Department of Pathological Anatomy, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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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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Khanh HQ, Vinh VH, Khoi NV, Vuong NL. Videothoracoscopic versus open resection in the treatment of mediastinal tumors: a prospective study. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Napolitano MA, Werba G, Desai SA, Sparks AD, Mortman KD. Presenting Symptomatology of Mediastinal Masses and Its Effect on Surgical Outcomes. Am Surg 2021; 88:212-218. [PMID: 33522269 DOI: 10.1177/0003134821989038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Mediastinal masses are commonly encountered by the thoracic surgeon. Few studies have reported on the frequency and characteristics of symptoms at presentation. The primary objective of this study is to determine how often patients present with symptoms from a mediastinal mass. The secondary objective is to determine if the presence of symptoms has an effect on outcomes after surgery. METHODS A retrospective review of an institutional database was performed. All patients who underwent surgical resection of a mediastinal mass from 2013 to 2019 were included in the analysis. Medical records were reviewed for the presence or absence of symptoms preoperatively, and these cohorts were compared. Multivariable analysis was performed, adjusting for clinical variables to assess for differences between these cohorts. RESULTS 70 patients underwent surgery for a mediastinal mass. The average age was 49.2 years, and 46 patients (65.7%) presented with symptoms. There were no significant differences in demographics between the symptomatic and asymptomatic groups. The most common symptom was dyspnea in 18 patients (22%), followed by chest pain (15 patients, 19%) and dysphagia (8 patients, 10%). When comparing symptomatic and asymptomatic patients, symptomatic patients had a larger tumor size (5.8 cm vs 3.8 cm, P = .04) and a longer length of stay (2.0 days vs 1.2 days, P = .02). CONCLUSIONS The majority of patients with mediastinal masses present with symptoms, with the most common symptom being dyspnea. Symptomatic patients are more likely to have a larger tumor and tend to have a longer length of hospital stay postoperatively compared to asymptomatic patients.
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Affiliation(s)
- Michael A Napolitano
- Department of Surgery, Division of Thoracic Surgery, 43963The George Washington University Hospital, Washington, DC, USA
| | - Gregor Werba
- Department of Surgery, Division of Thoracic Surgery, 43963The George Washington University Hospital, Washington, DC, USA
| | - Sonia A Desai
- Department of Surgery, Division of Thoracic Surgery, 43963The George Washington University Hospital, Washington, DC, USA
| | - Andrew D Sparks
- Department of Surgery, Division of Thoracic Surgery, 43963The George Washington University Hospital, Washington, DC, USA
| | - Keith D Mortman
- Department of Surgery, Division of Thoracic Surgery, 43963The George Washington University Hospital, Washington, DC, USA
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Abstract
Tracheobronchial pathology can be related to trauma, infection, tumor, or a combination of these. Per definition, planning for tracheobronchial surgery can be complicated by the overlap of anesthesiological interests in airway management and the primary surgical field. Therefore, following a detailed description of the stenosis, management of tracheobronchial surgery requires an interdisciplinary discussion and individualized planning of the procedure. There are several options for intraoperative ventilation depending on the exact localization of the defect. Hence, different tubes and ventilation techniques from cross-field ventilation, to jet ventilation, or even spontaneous breathing under regional anesthesia, have to be discussed. Moreover, an innovative ventilation mode called flow-controlled ventilation (FVC) has been developed, which allows to apply standard tidal volumes through a narrow-bore endotracheal tube. In addition, the Ventrain has been developed as an emergency device following the same technique of an active expiration based on the Venturi principle and a controlled gas flow. In critical situations, it allows even ventilation through the working channel of a bronchoscope. Overall, tracheobronchial surgery is performed under total intravenous anesthesia and the aim of an early extubation at the end of surgery. Airway management has to be discussed and planned between surgeon and anesthesiologist. All of the steps of the procedure need constant and clear communication.
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Affiliation(s)
- Anna Schleicher
- Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte, Essen, Germany
| | - Harald Groeben
- Department of Anesthesiology, Critical Care Medicine and Pain Therapy, Kliniken Essen-Mitte, Essen, Germany
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Khanh HQ, Van Khoi N, Vuong NL. Long-term outcome in mediastinal malignancies: video-assisted thoracoscopic versus open surgery. Indian J Thorac Cardiovasc Surg 2020; 37:44-52. [PMID: 33442207 DOI: 10.1007/s12055-020-01023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose There are not many studies comparing long-term oncological outcomes between video-assisted thoracoscopic surgery (VATS) and open surgery for mediastinal malignancies. This study aimed to compare perioperative and long-term outcomes of these two techniques in the treatment of mediastinal malignancies. Methods This is a retrospective study: patients with mediastinal malignancies underwent VATS or open surgery from 2010 to 2013 and were followed until 2019. The primary endpoints were long-term oncological outcomes, including tumor recurrence and mortality. Secondary endpoints were perioperative outcomes (operative duration, blood loss, pain, chest drainage duration, hospital length of stay, and complications). Results There were 36 patients in the VATS group and 49 patients in the open group. The median follow-up duration was 90 months. VATS significantly reduced operation time (84.6 versus 124.8 min), blood loss (59.8 versus 235.2 ml), postoperative pain score (4.9 versus 6.7), the duration of chest tube drainage (2.1 versus 3.1 days), and postoperative hospital stay (5.2 versus 8.0 days). The two groups were comparable regarding the recurrence rate (2.4 versus 2.1/100 person-years) and mortality rate (0.8 versus 0.9/100 person-years). Conclusion Compared with open surgery, VATS is less traumatic, reduces postoperative chest drainage, and shortens hospital stay with comparable long-term oncological outcomes. We advocate the VATS approach as a favored option for the resection of mediastinal malignancies.
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Affiliation(s)
- Huynh Quang Khanh
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Van Khoi
- Department of Thoracic Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Lam Vuong
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
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Komarov RN, Parshin VD, Chernyavsky SV, Ismailbaev AM. [Resection of recurrent hemangioma of the anterior mediastinum with aortic arch replacement and simultaneous resection of left atrial myxoma]. Khirurgiia (Mosk) 2020:114-117. [PMID: 32573542 DOI: 10.17116/hirurgia2020061114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patients with anterior mediastinum tumors fall into a difficult category due to high risk of invasion of vital structures and complexity of surgical correction. We report resection of recurrent hemangioma of anterior mediastinum with aortic arch replacement and simultaneous resection of left atrial myxoma in a 35-year-old woman. Successful treatment of these patients correlates with aggressive surgical approach followed by total resection of tumor and all affected vessels and other tissues.
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Affiliation(s)
- R N Komarov
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - V D Parshin
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - S V Chernyavsky
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - A M Ismailbaev
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
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Ketterl TG, Latham GJ. Perioperative Cardiothoracic and Vascular Risk in Childhood Cancer and its Survivors. J Cardiothorac Vasc Anesth 2020; 35:162-175. [PMID: 32360009 DOI: 10.1053/j.jvca.2020.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/11/2020] [Accepted: 02/28/2020] [Indexed: 11/11/2022]
Abstract
CHILDREN with cancer and survivors of childhood cancer have an increased risk of cardiovascular disease, and this risk in the perioperative period must be understood. During diagnosis and treatment of pediatric cancer, multiple acute cardiovascular morbidities are possible, including anterior mediastinal mass, tamponade, hypertension, cardiomyopathy,and heart failure. Childhood cancer survivors reaching late childhood and adulthood experience substantially increased rates of cardiomyopathy, heart failure, valvular disease, pericardiac disease, ischemia, and arrhythmias. Despite considerable advances in the understanding and therapeutic options of pediatric malignancies, cardiac disease remains the most common treatment-related, noncancer cause of death in childhood cancer survivors. Increasingly, molecularly targeted agents, including small molecule inhibitors, are being incorporated into pediatric oncology. The acute and chronic risks associated with these newer therapeutic options in children are not yet well-described, which poses challenges for clinicians caring for these patients. In the present review, the unique risks factors, prevention strategies, and treatment of cardiovascular toxicities of the child with cancer and the childhood cancer survivor are examined, with an emphasis on the perioperative period.
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Affiliation(s)
- Tyler G Ketterl
- Department of Pediatric Hematology and Oncology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Gregory J Latham
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
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Tian Z, Liu H, Li S, Chen Y, Ma D, Han Z, Huang C. Surgical treatment of benign mediastinal teratoma: summary of experience of 108 cases. J Cardiothorac Surg 2020; 15:36. [PMID: 32066478 PMCID: PMC7027083 DOI: 10.1186/s13019-020-1075-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mediastinal teratoma is a rare disease, many cases were reported before, but few articles focus on large case analyses. The objective of this article is to summarize the clinical characteristics of benign mediastinal teratoma and the experience of surgical treatment, especially thoracoscopic surgery for benign mediastinal teratoma. Methods The clinical data of 108 patients with benign mediastinal teratoma confirmed by operation and pathology from January 1992 to January 2018 were analyzed retrospectively. The clinical symptoms, imaging examination, surgical methods and prognosis of all patients were analyzed. We compared the difference of thoracoscopic surgery and thoracotomy surgery using 102 patients underwent only chest surgery. Normally distributed continuous variables were compared by independent sample t test. Categorical variables were analyzed by chi-square test. Results Imaging examination showed that all 108 cases of mediastinal teratoma were located in the anterior region of mediastinum. All cases underwent surgical resection, postoperative pathology confirmed that all cases were benign. 1 case was taken simple neck collar incision, 5 case was taken median thoracotomy combined with neck incision, other 102 cases were taken thoracoscopic surgery (22) or thoracotomy surgery (80). 4 cases were treated with partial pericardial resection due to adhesions, 12 cases underwent partial pericardial resection, 5 cases underwent lobectomy, 9 cases underwent wedge resection of lobe, and 2 patients underwent anonymous vein angioplasty. 1 case underwent second operation because of postoperative bleeding, 1 case of chylothorax, 1 case of recurrent laryngeal nerve injury, 2 cases of wound infection, 1 case of secondary pulmonary infection. 106 cases were followed up, period from 12 months to 10 years, no recurrence of tumor was found. Comparing to take thoracotomy surgery, patients underwent thoracoscopic surgery has strong advantage on intraoperative blood loss and hospital stay days after surgery (P < 0.05). tumor maximum diameter is larger for thoracotomy surgery group, as well as more patients suffer estimated adhesions from preoperative imaging. so we compared above parameters in patients with tumor diameter less than 10 cm with or without estimated adhesions from preoperative imaging, a strong advantage still can be found in thoracoscopic surgery group, inpatients with estimated adhesions from preoperative imaging, intraoperative blood loss (38.75 ± 15.53 vs 169.17 ± 208.82., P = 0.04) and hospital stay days after surgery (5.50 ± 0.93 vs 9.43 ± 6.54., P = 0.04) were better. In patients without estimated adhesions from preoperative imaging, intraoperative blood loss (46.67 ± 10.00 vs 110.53 ± 123.13., P = 0.06) and hospital stay days after surgery (4.70 ± 1.16 vs 7.53 ± 2.32., P = 0.01) were better. Especially, in thoracoscopic surgery group, hospital stay days after surgery was significantly shorter. Conclusion The clinical manifestations and imaging performance of benign mediastinal teratoma were complicated, and the surgical treatment was effective. Compared with traditional thoracotomy surgery, thoracoscopic surgery can improve patients’ quality of life, less intraoperative blood loss, and less hospital stay days after surgery, so if condition is permitted, thoracoscopic surgery should be a better choice.
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Affiliation(s)
- Zhenhuan Tian
- Department of Thoracic surgery, Peking Union Medical College Hospital, Peking Union Medical College, Dong cheng District, Beijing, 100730, China
| | - Hongsheng Liu
- Department of Thoracic surgery, Peking Union Medical College Hospital, Peking Union Medical College, Dong cheng District, Beijing, 100730, China.
| | - Shanqing Li
- Department of Thoracic surgery, Peking Union Medical College Hospital, Peking Union Medical College, Dong cheng District, Beijing, 100730, China
| | - Yeye Chen
- Department of Thoracic surgery, Peking Union Medical College Hospital, Peking Union Medical College, Dong cheng District, Beijing, 100730, China
| | - Dongjie Ma
- Department of Thoracic surgery, Peking Union Medical College Hospital, Peking Union Medical College, Dong cheng District, Beijing, 100730, China
| | - Zhijun Han
- Department of Thoracic surgery, Peking Union Medical College Hospital, Peking Union Medical College, Dong cheng District, Beijing, 100730, China
| | - Cheng Huang
- Department of Thoracic surgery, Peking Union Medical College Hospital, Peking Union Medical College, Dong cheng District, Beijing, 100730, China
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Marouf R, Alloubi I. Hydatid cyst of the pericardium mimicking a right atrial myxoma. Indian J Thorac Cardiovasc Surg 2019; 35:502-506. [PMID: 33061038 DOI: 10.1007/s12055-019-00797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/10/2019] [Accepted: 01/16/2019] [Indexed: 11/30/2022] Open
Abstract
The hydatid cyst of the pericardium is a rare pathology; its clinical presentation is variable. It can reveal straightaway at the stage of life-threatening complications. Only a few cases of isolated pericardial hydatid cysts have been reported. Echocardiography, computed tomography, and magnetic resonance imaging are important diagnostic tools for the diagnosis of echinococcosis, and surgery remains the treatment of choice. Herein, we report a rare case of pericardial hydatid cyst who presented to our emergency department with complaints of palpitations, chest pain, and shortness of breath.
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Affiliation(s)
- Rachid Marouf
- Department of Thoracic and Cardiovascular Surgery, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Ihsan Alloubi
- Department of Thoracic and Cardiovascular Surgery, Mohammed VI University Hospital Center, Oujda, Morocco
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42
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Carro SE, Essex DW, Alsammak M, Bains A, Toyoda Y, Keshavamurthy S. Mediastinal Lymphoma Presenting in Cardiogenic Shock with Superior Vena Cava Syndrome in a Primigravida at Full Term: Salvage Resection after Prolonged Extracorporeal Life Support. Case Rep Oncol 2019; 12:401-410. [PMID: 31244642 PMCID: PMC6587197 DOI: 10.1159/000499195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/19/2022] Open
Abstract
Primary mediastinal large B-cell lymphoma (PMBCL) is a rare type of non-Hodgkin lymphoma that typically has a good response rate to first line chemotherapy regimens. There have been reports of successful chemotherapy, but with a residual mass from fibrosis. Here, we report the case of a 19-year-old primigravida presenting with cardiogenic shock and superior vena cava (SVC) syndrome at full term who was found to have a PMBCL. Following delivery via urgent cesarean section, she was put on veno-arterial extra corporeal membrane oxygenation (VA-ECMO) and once hemodynamically stable was started on chemotherapy. In view of limited change in tumor size on consecutive CT scans and questionable response to chemotherapy, there were multidisciplinary meetings wherein withdrawing support was discussed and put forward to the family. At that point, surgical debulking was offered on compassionate grounds to be able to wean her off the VA-ECMO. This case report highlights the role of salvage resection when there are no other options.
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Affiliation(s)
- Sabrina E Carro
- MD Candidate 2020, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - David W Essex
- Department of Hematology and Oncology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Mohamed Alsammak
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Ashish Bains
- Department of Pathology and Laboratory Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Yoshiya Toyoda
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Suresh Keshavamurthy
- Department of Cardiovascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
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Regional anaesthesia with extracorporeal membrane oxygenation backup for caesarean section in a parturient with neck and mediastinal masses. Int J Obstet Anesth 2018; 35:99-103. [DOI: 10.1016/j.ijoa.2018.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/18/2018] [Accepted: 02/27/2018] [Indexed: 12/17/2022]
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Intraoperative Tracheal Obstruction Management among Patients with Anterior Mediastinal Masses. Case Rep Med 2018; 2018:4895263. [PMID: 30073027 PMCID: PMC6057329 DOI: 10.1155/2018/4895263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/13/2018] [Accepted: 06/10/2018] [Indexed: 11/18/2022] Open
Abstract
Background Patients suffering from undiagnosed obstruction of the central airways: the trachea and main stem bronchi are at increased risk for perioperative and postoperative complications, especially if general anesthesia is performed. Case Description This report discusses a 30-year-old asymptomatic Caucasian female who faced recurrent distal airway collapse during mediastinoscopy for biopsy of an anterior mediastinal mass, which led to the inability to extubate her. This case examines the necessity of a thorough preoperative assessment especially in patients with undiagnosed tracheal obstruction and a precise coordination between anesthesiologist and surgeon in being able to perform a safe and smooth anesthesia, in order to avoid life-threatening complications and to reduce further morbidity. Methods The scope of this case report is restricted to publications in all surgical and anesthesiological specialties among adult patient population. Main search key words were as follows: "tracheal obstruction," "general anesthesia," "mediastinum," and "tumors" Results. The literature supports an increased perioperative risk of airway obstruction with the use of general anesthesia in patients with anterior mediastinal masses. This case report suggests a perioperative anesthetic management modality for patients presenting with anterior mediastinal masses and who are at high risk of cardiovascular compression and tracheal obstruction. Thus, it is highly important to note that evidence-based recommendations are not available in the literature. Conclusions This case report suggests perioperative management modalities performed by anesthesiologists in order to minimize the risk of airway obstruction among patients having anterior mediastinal masses and shed the lights on the importance of proper anesthetic and surgical planning in order to prevent intraoperative complications and improve the quality of healthcare provided to patients presenting critical cases.
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Amore D, Cicalese M, Scaramuzzi R, Di Natale D, Casazza D, Curcio C. Hybrid robotic thoracic surgery for excision of large mediastinal masses. J Vis Surg 2018; 4:105. [PMID: 29963394 DOI: 10.21037/jovs.2018.05.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/08/2018] [Indexed: 11/06/2022]
Abstract
Between April 2016 and October 2017, we retrospectively reviewed all patients undergoing excision of large mediastinal masses using a hybrid robotic thoracic approach at the Unit of Thoracic Surgery of Monaldi Hospital in Naples. The inclusion criteria for this approach were: evident unilateral predominance of the mass; absence of invasion to surrounding structures. Planned conversion to sternotomy was necessary in one patient for tenacious adhesions between the mediastinal goiter and the left innominate vein. In all cases the postoperative course was uneventful. The hybrid robotic approach, adopted in our Unit, consists of a thoracic procedure performed completely with articulated surgical instruments under three-dimensional vision and followed by final extension of a port-site incision to retrieve the voluminous specimen. This approach uses all the advantages of robotic technology that enables to perform a fine dissection in the small space of the anterior mediastinum and at the same time, through the simple extension of a minimally invasive access, avoids the painful sequelae of thoracotomy. In selected cases, with increased experience in robotic surgery, it can be proposed for excision of large mediastinal masses, although a longer follow-up period is necessary to validate our findings.
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Affiliation(s)
- Dario Amore
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | | | | | | | - Dino Casazza
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
| | - Carlo Curcio
- Division of Thoracic Surgery, Monaldi Hospital, Naples, Italy
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Zhu R, Duan S, Yang W, Shi L, Zhang F, Chen Y. [Surgical Treatment of Refractory Chest Tumors Assisted
by Cardiopulmonary Bypass]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:313-317. [PMID: 29587914 PMCID: PMC5973330 DOI: 10.3779/j.issn.1009-3419.2018.04.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
背景与目的 回顾性总结体外循环辅助下累及心脏或大血管的难治性胸部肿瘤外科治疗体会。 方法 总结我院2008年1月-2017年5月实施的体外循环下外科手术切除累及心脏或大血管的11例胸部肿瘤患者,分析所有患者的一般情况、临床特征、治疗方法、术后住院时间、并发症及随访结果。 结果 11例患者均在体外循环辅助下手术。肿瘤全部切除者8例,大部分切除者3例,其中1例先行左房内转移性肺平滑肌肉瘤切除,再行右肺中下叶切除术;1例经胸骨正中切口行左肺中央型肺癌切除术;2例同时行肺动脉修补术,3例同时行部分心包切除术,3例同时行肺楔形切除术。所有患者术后症状均得到有效缓解。无院内及术后30天死亡率。3例术后出现肺部感染,于抗生素治疗后恢复。1例淋巴瘤术后6个月复发,1年后死亡;1例心包内纤维肉瘤患者于术后13个月局部复发伴广泛转移,15个月死亡,1例肺平滑肌肉瘤患者于术后15个月发现局部复发灶,予以化疗后缓解。其余8例患者均存活,且计算机断层扫描(computed tomography, CT)检查均未发现明显复发及远处转移。 结论 对于累及心脏或大血管的难治性胸部肿瘤可以实施体外循环辅助下的外科手术治疗,可以提高难治性胸部肿瘤的手术切除率,有效缓解对呼吸、循环功能的影响,明显延长此类患者的生存期。
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Affiliation(s)
- Rongying Zhu
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Shanzhou Duan
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Wentao Yang
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Li Shi
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Fuquan Zhang
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Yongbing Chen
- Department of Cardiothoracic Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
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Santini M, Fiorelli A. Surgery: Recommendations for Surgeons. CURRENT CLINICAL PATHOLOGY 2018:43-64. [DOI: 10.1007/978-3-319-90368-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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