Surgical resection of primary intracardiac sarcomas and outcomes: A review of case reports over 20 years

Objective

A quarter of all cardiac tumors are malignant, and most (~ 95%) are sarcomas. It is the most aggressive malignant cardiac tumor carrying the worst prognosis. Tumor involvement with the vital intracardiac structures makes it difficult for complete surgical resection. We aimed to study the role of complete surgical resection and its importance in long-term outcomes.

Methods

We analyzed published literature from 2002 to 2022 using PubMed. Cases reported adult, intracardiac sarcomas, and received surgical resections were included. We reviewed 132 published case reports, including and analyzed the following variables: demographics, clinical presentations, diagnostic imaging modality, the extent of surgical resection, pathological diagnosis, tumor location, postoperative chemo-radiation therapy, and follow-up (including re-operation, local and distant recurrence).

Results

A total of 135 patients are included from 132 articles. The mean age was 46.69 (18-86) and 76 patients were females. The main complaints were dyspnea (70%) and chest pain (32%). Performed investigations were transthoracic echocardiography (TTE) in 114/135 (84%), computer tomography (CT) scan 89/135 (66%), trans-esophageal echocardiography (TOE) 22%, and cardiac magnetic resonance imaging (MRI) 29%. The most common location was the atrium (left 46%, right 30%). Complete surgical resection was performed in 91 cases (67%), and frozen section was performed in 62 patients (43 positives). Incomplete resections were in 42 cases. Patients who underwent complete surgical resection had mean survival of 14.58 months and median of 10.5 months, compared to incomplete resection patients with 9.12 months and 6.5 months respectively.

Conclusion

Our review shows complete surgical resection results in better short- and long-term outcomes in intracardiac sarcoma patients. Furthermore, combining chemo-radiotherapy has additional benefits towards long-term survival.

Surgical treatment of a primary malignant pericardial mesothelioma: case report

Pericardial malignant mesothelioma (MM) is a rare tumour which accounts for about 1% of all mesotheliomas, 4% of the primary heart and pericardial tumours. It carries an extremely poor prognosis, with a reported overall survival of less than 6 months. Clinical symptoms and signs are frequently nonspecific, and the diagnosis is usually made after surgery or at autopsy. We report a case of a 72 years old woman with primary pericardial malignant mesothelioma involving the right atrium. Nine months following surgery, the patient is alive with good performance status.

Modified prone position to dissect the popliteal fossa

Introduction

Traditionally, the prone position is used for dissecting the popliteal fossa, which requires endotracheal intubation. Access to the airway in this position is limited, hence the complications. It is not surprising that the prone position is not favoured by the anaesthetists, especially in patients with a high body mass index. We describe a safe and novel alternative to the prone position.

Methods

The modified prone position (MPP) is described as an alternative position that facilitates access to the airway.

Results

Between October 2007 and May 2010, 12 patients underwent popliteal fossa dissection using the MPP. All patients had general anaesthesia using a laryngeal mask airway with the exception of one, who had an epidural anaesthesia. There were no airway or haemodynamic complications. The surgical access to the popliteal fossa was as good as with the traditional prone position.

Conclusions

The MPP was satisfactory for both the surgeon and the anaesthetists. The authors now use this position routinely for dissecting the popliteal fossa.

Two synchronous non small cell lung carcinomas with different morphologies in the same lobe

We report the case of a sixty one year old female diagnosed with two synchronous primary lung cancers located within the same lobe. Surgical resection was performed, followed by adjuvant chemotherapy. The patient developed distant bone and skin metastases one year post-surgical resection. In this report we discuss the multimodality therapy used to treat this patient.