Surgical treatment of benign mediastinal neurogenic tumors – a 7-year analysis

Czech version

Authors: Radek Pohnán ^1,2; J. Herzinger ²; P. Vaněk ³; J. Mališ ²; A. Tašková ²; D. Netuka ³
Authors‘ workplace: Chirurgická klinika, 2. LF UK a ÚVN – VFN, Praha ¹; Oddělení hrudní chirurgie, Thomayerova nemocnice, Praha ²; Neurochirurgická a neuroonkologická, klinika 1. LF UK a ÚVN – VFN, Praha ³
Published in: Cesk Slov Neurol N 2020; 83(2): 184-188
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2020184

Overview

Aim: Benign intrathoracic neurogenic tumors are neoplasms with low frequency prevalence ocurring predominantly in the posterior mediastinum. Video-assisted thoracoscopic surgery (VATS) enables minimally invasive surgical treatment in a number of intrathoracic diseases. The aim of this work was to compare the results of operations of neurogenic tumors of the mediastinum by VATS and open resection.

Patients and methods: We retrospectively analyzed the set of 22 patients who underwent surgery between 2013–2018 for benign neurogenic tumors of the mediastinum.

Results: The average age in the group was 57 years, 73% were women. 19 patients (86.4%) were asymptomatic and their tumors were accidental findings. Based on the histological examination 20 cases (90.9%) were neurinomas, 1 case (4.5%) was a paraganglion and 1 case (4.5.%) was a neurofibroma. There were no operative deaths in the group. Postoperative morbidity was 13.6%. VATS patients had significantly lower blood loss (42.5 ± 52.6 vs. 95 ± 48 mL; P = 0.033), shorter hospital stay (6.9 ± 1.5 vs. 11 ± 2.6 days; P = 0.008) and lower incidence of complications (6.25 vs. 33%; P = 0.001). There was no significant difference between the groups compared in the length of operations (78 ± 22.3 vs. 87 ± 72.2 min; P = 0.393) and tumor size (40 ± 19.9 vs. 61 ± 54.7 mm; P = 0.074). No tumor relapse occurred during the follow-up period (mean 34 months).

Conclusion: VATS represents a safe and effective surgical method in the treatment of benign mediastinal tumors. Compared to open access, VATS achieved better results in lower blood loss, shorter hospital stay and lower frequency of complications.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers

Keywords:

surgery – neurinoma – mediastinum – video-assisted thoracoscopic surgery

Sources

1. Reeder LB. Neurogenic tumors of the mediastinum. Semin Thorac Cardiovasc Surg 2000; 12 (4): 261–267. doi: 10.1053/stcs.2000.16738.

2. Cardillo G, Carleo F, Khalil MW et al. Surgical treatment of benign neurogenic tumours of the mediastinum: a single institution report. Eur J Cardiothorac Surg 2008; 34 (6): 1210–1214. doi: 10.1016/j.ejcts.2008.09.006.

3. Mlika M, Marghli A, Souilem I et al. A single-institution experience of neurogenic tumors of the mediastinum. Asian Cardiovasc Thorac Ann 2019; 27 (8): 661–669. doi: 10.1177/0218492319878575.

4. Davidson KG, Walbaum PR, McCormack RJ. Intrathoracic neural tumors. Thorax 1978; 33 (3): 359–367. doi: 10.1136/thx.33.3.359.

5. Takeda S, Miyoshi S, Minami M et al. Intrathoracic neurogenic tumors-50 years’ experience in a Japanese institution. Eur J Cardiothorac Surg 2004; 26 (4): 807–812. doi: 10.1016/j.ejcts.2004.07.014.

6. Pohnan R, Ryska M, Hytych V et al. Echinococcosis mimicking liver malignancy: a case report. Int J Surg Case Rep 2017; 36: 55–58. doi: 10.1016/j.ijscr.2017.04.032.

7. Kumar A, Kumar S, Aggarwal S et al. Thoracoscopy: the preferred approach for the resection of selected posterior mediastinal tumors. J Laparoendosc Adv Surg Tech A 2002; 12 (5): 345–353. doi: 10.1089/ 109264202320884090.

8. Hytych V, Horazdovsky P, Pohnan R et al. VATS lobectomy, history, indication, contraindication and general techniques. Bratisl Lek Listy 2015; 116 (7): 400–403. doi: 10.4149/BLL_2015_076.

9. Silverman NA, Sabiston DC. Mediastinal masses. Surg Clin North Am 1980; 60 (4): 757–777. doi: 10.1016/s0039-6109 (16) 42181-x.

10. Liu HP, Yim AP, Wan J et al. Thoracoscopic removal of intrathoracic neurogenic tumors: a combined Chinese experience. Ann Surg 2000; 232 (2): 187–190. doi: 10.1097/00000658-200008000-00006.

11. Riquet M, Mouroux J, Pons F et al. Videothoracoscopic excision of thoracic neurogenic tumors. Ann Thorac Surg 1995; 60 (4): 943–946. doi: 10.1016/0003-4975 (95) 00487-6.

12. Landreneau RJ, Dowling RD, Ferson PF. Thoracoscopic resection of a posterior mediastinal neurogenic tumor. Chest 1992; 102 (4): 1288–1290. doi: 10.1378/ chest.102.4.1288.

13. Shields TW. Benign and malignant neurogenic tumors of the mediastinum in adults. In: Shields TW (ed). Mediastinal Surgery. Philadelphia: Lea & Febiger 1992: 241– 253.

14. Demmy TL, Krasna MJ, Detterbeck FC et al. Multicenter VATS experience with mediastinal tumors. Ann Thorac Surg 1998; 66 (1): 187–192. doi: 10.1016/s0003-4975 (98) 00378-6.

15. Zierold D, Halow KD. Thoracoscopic resection as the preferred approach to posterior mediastinal neurogenic tumors. Surg Laparosc Endosc Percutan Tech 2000; 10 (4): 222–225.

16. Hytych V, Horazdovsky P, Stehlik L et al. Our own method of fixation of biodegradable tracheal stent. Bratisl Lek Listy 2015; 116 (5): 340–342. doi: 10.4149/bll_2015_064.

17. Sakumoto N, Inafuke S, Shimoji H et al. Video thoracoscopic surgery for thoracic neurogenic tumors: a 7-year experience. Surg Today 2000; 30 (11): 974–977. doi: 10.1007/s005950070016.

18. Grillo HC, Ojemann RG, Scannell G et al. Combined approach to “dumbbell” intrathoracic and intraspinal neurogenic tumors. Ann Thorac Surg 1983; 36 (4): 402–407.

19. Negri G, Puglisi A, Gerevini S et al. Thoracoscopic techniques in the management of benign mediastinal dumbbell tumors. Surg Endosc 2001; 15 (8): 897. doi: 10.1007/s004640042001.

20. Okada D, Koizumi K, Haraguchi S et al. A case of dumbbell tumor of the superior mediastinum removed by combined thoracoscopic surgery. J Nippon Med School 2002; 69 (1): 58–61. doi: 10.1272/jnms. 69.58.