Surgical Management of Mediastial Tumor Invading the Heart or Great Vessels_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIELiang ,  CHENGang , DENGCheng , TANGJi-ming , XIAOPu , ZHOUHai-yu , BENXiao-song , ZHOUZi-hao , YEXiong , ZHANGDong-kun

Department of Thoracic Surgery, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou 510080, P. R. China;

Corresponding?author：

CHENGang, Email: chenganggz@126.com

Keywords：

Mediastinal tumor; Surgical treatment; Heart or great vessels

DOI：

10.7507/1007-4848.20160010

Video：

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Objective To summarize the surgical management of complicated mediastinal tumor involving the heart or great vessels. Methods We retrospectively analyzed the clinical data of 38 patients with complicated mediastinal tumor invading the heart and large blood vessels underwent extended thymectomy in our hospital between February 1997 and May 2014. There were 26 males and 12 females at age of 41.3± 13.6 years ranking from 4 to 68 years. Multiple personalized procedures were applied within the 38 patients and some patients underwent more than one procedure. Besides the resection of mediastinal tumor, 3 patients underwent partial right atrial resection. Sixteen patients underwent resection, plasty or grafting vessels. Ten patients took partial excision and repair of pericardium. Eight patients underwent pulmonary wedge resection. Two patients underwent lobectomy. Two patients required cardiopulmonary bypass. Result All operations were completed successfully. There was no perioperative mortality. The operating time was 105-282 min and blood loss was 200-1 500 ml. The postoperative complications rate was 23.7%. The incidence of ICU admission was 47.4% with an average ICU stay of 1.8 days. The average length of post-operative hospital stay was 11.2 days. The five-year survival rate was 57.0%. Conclusion Surgical resection of mediastinal tumor invading the heart or great vessels is complicated and highly risky. However, desirable clinical outcome can be achieved with comprehensive perioperative assessment and appropriate surgical procedures.

Citation： XIELiang, CHENGang, DENGCheng, TANGJi-ming, XIAOPu, ZHOUHai-yu, BENXiao-song, ZHOUZi-hao, YEXiong, ZHANGDong-kun. Surgical Management of Mediastial Tumor Invading the Heart or Great Vessels. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(1): 38-43. doi: 10.7507/1007-4848.20160010 Copy

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5.	楊永波, 尤嘉琮, 周清華.胸部腫瘤引起的上腔靜脈綜合征的外科治療.中國肺癌雜志, 2009, 12(9): 1018-1021.
6.	劉玉金, 張孝軍, 宋鵬, 等.縱隔腫瘤血管造影及栓塞的臨床應用.介入放射學雜志, 2012, 21(11): 916-920.
7.	Falkson CB, Bezjak A, Darling G, et al. The management of thymoma: a systematic review and practice guideline. J Thorac Oncol, 2009, 4(7): 911-919.
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10.	Ried M, Neu R, Schalke B, et al. Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg, 2015, 10: 137.
11.	D'Andrilli A, Venuta F, Rendina EA. Surgical approaches for invasive tumors of the anterior mediastinum. Thorac Surg Clin, 2010, 20(2): 265-284.
12.	梁恒星, 劉文亮, 王翔, 等.惡性胸腺瘤侵犯大血管的手術治療及術后生存調查.中國現代手術學雜志, 2013, 17(2): 142-147.
13.	Ried M, Potzger T, Sziklavari Z, et al. Extended surgical resections of advanced thymoma masaoka stagesⅲand via facilitate outcome. Thorac Cardiovasc Surg, 2014, 62(2): 161-168.
14.	Gross JL, Rosalino UA, Younes RN, et al. Characteristics associated with complete surgical resection of primary malignant mediastinal tumors. J Bras Pneumol, 2009, 35(9): 832-838.
15.	Kim D, Kim SW, Hong JM. Rapid growing huge teratoma: complete surgical resection. J Thorac Dis, 2014, 6(10): E217-E219.
16.	Rusch VW. Extrapleural pneumonectomy and extended pleurectomy/decortication for malignant pleural mesothelioma: the memorial sloan-kettering cancer center approach. Ann Cardiothorac Surg, 2012, 1(4): 523-531.
17.	Kawamukai K, Antonacci F, Di Saverio S, et al. Acute postoperative cardiac herniation. Interact Cardiovasc Thorac Surg, 2011, 12(1): 73-74.
18.	王茜, 龍村.順行性腦灌注與逆行性腦灌注.中國體外循環雜志, 20119(1): 48-52.
19.	Yoshioka M, Ichiguchi O, Hirayama T, et al. Radical excision of thymic adenocarcinoma with selective cerebral perfusion. Ann Thorac Surg, 2008, 85(4): 1427-1429.
20.	胡英斌, 胡野榮, 李津, 等.血管重建在原發性縱隔腫瘤中的臨床應用.中國現代手術學雜志, 200913(5): 351-353.

1. Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest, 2005, 128(4): 2893-2909.
2. 王振捷, 于洪泉, 任華, 等.上腔靜脈和無名靜脈的切除及重建治療縱隔腫瘤.中國胸心血管外科臨床雜志, 2005, 12(1): 22-25.
3. Park BJ, Bacchetta M, Bains MS, et al. Surgical management of thoracic malignancies invading the heart or great vessels. Ann Thorac Surg, 2004, 78(3): 1024-1030.
4. Motus IY, Bazhenov AV, Massard G. Surgery for huge mediastinal tumors. Asi Cardiovasc Thorac Ann, 2015, 23(7): 846-850.
5. 楊永波, 尤嘉琮, 周清華.胸部腫瘤引起的上腔靜脈綜合征的外科治療.中國肺癌雜志, 2009, 12(9): 1018-1021.
6. 劉玉金, 張孝軍, 宋鵬, 等.縱隔腫瘤血管造影及栓塞的臨床應用.介入放射學雜志, 2012, 21(11): 916-920.
7. Falkson CB, Bezjak A, Darling G, et al. The management of thymoma: a systematic review and practice guideline. J Thorac Oncol, 2009, 4(7): 911-919.
8. Burt M, Ihde JK, Hajdu SI, et al. Primary sarcomas of the mediastinum: results of therapy. J Thorac Cardiovasc Surg, 1998, 115(3): 671-680.
9. Garcia A, Flores RM. Surgical management of tumors invading the superior vena cava. Ann Thorac Surg, 2008, 85(6): 2144-2146.
10. Ried M, Neu R, Schalke B, et al. Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg, 2015, 10: 137.
11. D'Andrilli A, Venuta F, Rendina EA. Surgical approaches for invasive tumors of the anterior mediastinum. Thorac Surg Clin, 2010, 20(2): 265-284.
12. 梁恒星, 劉文亮, 王翔, 等.惡性胸腺瘤侵犯大血管的手術治療及術后生存調查.中國現代手術學雜志, 2013, 17(2): 142-147.
13. Ried M, Potzger T, Sziklavari Z, et al. Extended surgical resections of advanced thymoma masaoka stagesⅲand via facilitate outcome. Thorac Cardiovasc Surg, 2014, 62(2): 161-168.
14. Gross JL, Rosalino UA, Younes RN, et al. Characteristics associated with complete surgical resection of primary malignant mediastinal tumors. J Bras Pneumol, 2009, 35(9): 832-838.
15. Kim D, Kim SW, Hong JM. Rapid growing huge teratoma: complete surgical resection. J Thorac Dis, 2014, 6(10): E217-E219.
16. Rusch VW. Extrapleural pneumonectomy and extended pleurectomy/decortication for malignant pleural mesothelioma: the memorial sloan-kettering cancer center approach. Ann Cardiothorac Surg, 2012, 1(4): 523-531.
17. Kawamukai K, Antonacci F, Di Saverio S, et al. Acute postoperative cardiac herniation. Interact Cardiovasc Thorac Surg, 2011, 12(1): 73-74.
18. 王茜, 龍村.順行性腦灌注與逆行性腦灌注.中國體外循環雜志, 20119(1): 48-52.
19. Yoshioka M, Ichiguchi O, Hirayama T, et al. Radical excision of thymic adenocarcinoma with selective cerebral perfusion. Ann Thorac Surg, 2008, 85(4): 1427-1429.
20. 胡英斌, 胡野榮, 李津, 等.血管重建在原發性縱隔腫瘤中的臨床應用.中國現代手術學雜志, 200913(5): 351-353.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Management of Mediastial Tumor Invading the Heart or Great Vessels

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