Comparison of video-assisted thoracic surgery with open surgery in the treatment of ectopic mediastinal parathyroid tumors

Abstract

Background: To investigate the therapeutic effect of different surgical treatment for ectopic mediastinal parathyroid tumors and pathological features.Methods: A total of 21 patients who were diagnosed with ectopic mediastinal parathyroid tumors and underwent surgeries in our department from May 1995 to May 2015 were collected and retrospectively analyzed.Results: Twenty-one patients including 8 female (36.4%) and 13 male (63.6%) were collected. Among these patients, 9 cases were treated with video-assisted thoracic surgery (VATS), while 13 cases were treated with open surgery (including one secondary open operation after thoracoscopic operation). The average size of mediastinal tumors was 2.17±1.22 cm. For the post-operational pathology, 16 cases (76.2%) were diagnosed as ectopic parathyroid adenoma; 4 cases (19.0%) were diagnosed as parathyroid hyperplasia, while only 1 case (4.8%) was diagnosed as parathyroid adenocarcinoma.Conclusions: Parathyroid adenoma accounts for the major pathological type of ectopic mediastinal parathyroid tumors. In addition, the correct diagnosis with precise preoperative location was the key for the treatment of ectopic mediastinal parathyroid tumors accompanied with hyperparathyroidism. Surgical intervention was demonstrated to be an effective way for the treatment of ectopic mediastinal parathyroid tumors with satisfied therapeutic outcome, especially for the VATS due to its unique clinical advantages.However, there may some difficulties when locating ectopic mediastinal parathyroid tumor less than 1 cm and the operators should be very cautious when performing thoracoscopic operations. Ruijin Hospital within recent 20 years were collected and retrospectively analyzed, including both surgical procedures and pathological studies. MethodsThis study included 21 cases of patients (13 males and 8 females) who were diagnosed with ectopic mediastinal parathyroid tumors and treated with surgical resection from May 1995 to May 2015 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. Written informed consent was obtained from all the patients for clinical data collection and accompanying images, as well as potential publication. All the patients underwent the examination of blood calcium, blood phosphorus and PTH before and after surgery. The location of the tumors was examined by computed tomography (CT), magnetic resonance imaging (MRI), or Technetium-99m sestamibi scanning ( 99m Tc-MIBI). Technetium-99m sestamibi scanning is considered the gold standard for clinical location. Ectopic mediastinal parathyroid tumors were finally confirmed by post-operational pathology. After surgery, all the patients followed up at least every three months till one year postoperation. Statistical analysisThe software SPSS13.0 was utilized for statistical analysis. The measurement data was analyzed by t-test and the count data was analyzed by χ 2 test. Results Clinical informationTwenty-one patients were firstly found hypercalcemia by physical examination without any specific symptoms, and...

Video‐assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma

“…The literature review identified nine English‐language case series consisting of five or more VATS parathyroidectomies, with a combined total of 87 patients ( Table ). PHPT was the most common pathology treated (51 of 69), and 54 per cent of patients (34 of 63) had undergone previous non‐curative neck exploration, consistent with the present patient group.…”

“…Video‐assisted thoracoscopic surgery (VATS) for ectopic mediastinal parathyroid adenoma was first described over 20 years ago, but significant experience has been acquired only in centres performing large numbers of parathyroidectomies. It is an attractive approach for appropriately selected patients, with literature suggesting a shorter hospital stay and lower complication rates. National Institute for Health and Care Excellence (NICE) guidelines note that there are limited published data on VATS parathyroidectomy, and recommend the procedure should be performed only in specialist units with a multidisciplinary team.…”

Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid tumor: subxiphoid and lateral thoracic approach

“…Approaches to the thymus include median sternotomy, lateral thoracic thoracotomy, mediastinoscopy, manubriotomy, cervical collar incision, and thoracoscopic surgeries using the lateral and subxiphoid approaches. Recently, thoracoscopic surgery using the lateral thoracic approach has become the primary option for minimally invasive surgery (2)(3)(4)(5)(6)(7)(8). However, intercostal neuralgia is a common complication associated with thoracoscopic surgery performed using the lateral thoracic approach (12).…”

“…Surgical approaches for mediastinal tumors include median sternotomy, lateral thoracotomy, mediastinoscopy, manubriotomy, transcervical incision, and thoracoscopic surgery using the lateral and subxiphoid approaches. Currently, thoracoscopic surgery using the lateral thoracic approach is the most common procedures (2)(3)(4)(5)(6)(7)(8). We have been performing multi-port mediastinal tumor resection using the lateral thoracic approach since 2008 and single-port mediastinal tumor resection using the subxiphoid approach since 2011 for mediastinal tumors (9).…”