Trends, Symptoms, and Outcomes of Resectable Giant Mediastinal Tumors

Abstract

Describing the changes in surgical procedures and factors affecting the surgical outcome of patients who have undergone complete resection of giant mediastinal tumors (GMTs, diameter ≥ 10 centimeters) could improve preoperative decision-making and prognostic evaluations. We accessed data from three sources, which are case reports on surgical treatment of GMTs from PubMed, Web of Science, and EMBASE until June 1, 2019; patients with resected GMT from the Surveillance, Epidemiology, and End Results (SEER) database; and retrospective review of medical records in our institution from 2000 to 2019. The worldwide distribution, clinicopathological characteristics, symptom profile, prognosis of patients with GMT resection, and nomogram for surgical outcome prediction are reported. A total of 242 rare GMT cases from four continents (Asia, North America, South America, and Europe) were included. The median age of the patients was 40 (IQR: 27, range: 13–83) years, and the male-to-female ratio was 1.57:1. Dyspnea, shortness of breath, cough, and chest pain or discomfort were the major symptoms at presentation. The prognosis of benign and low-grade malignant GMTs was superior to that of high-grade malignant GMTs. Tumor malignancy played the most critical role in predicting postoperative survival, followed by longest tumor diameter and a posterior mediastinum location. The findings of this study suggest that the number of successful GMT surgeries has increased over the last decade and describe clinical features of GMTs. Physicians should prioritize tumor malignancy as a leading factor in predicting outcome rather than tumor size.

Application of Computer-Assisted Surgery System Based on Artificial Intelligence in Pediatric Precise Oncological Surgery

“…However, because there are many important organs and structures in the mediastinum, such as the heart, superior vena cava, trachea, and esophagus, the thorax, which has a bony structure, is not as elastic as the abdomen. Because they have less space for cushioning, mediastinal masses are prone to compressing important organs and the corresponding symptoms, namely, mediastinal mass syndrome (MMS) [25]. Compared with that in adults, the thoracic cavity in children is relatively smaller in size, and therefore, its complex anatomic-spatial relationships and dense vascularneural structures have brought more challenges for surgical treatment [26].…”

The significance of a ‘T shaped’ incision for resection of giant mediastinal tumors: a case report

“…Giant mediastinal tumors (GMTs) are extremely uncommon with varying definitions in the literature, described either as occupying at least half of the hemithorax or having a diameter exceeding 10 cm [ 1 ] or 20 cm [ 2 ]. Germ cell tumors (33%), liposarcoma (10%), and thymoma (10%) are the primary causes of GMTs [ 1 ].…”

“…In the anterior mediastinum, common approaches for GMT resection include anterolateral thoracotomy and median sternotomy. For posterior mediastinal GMTs, posterolateral thoracotomy is preferred, and for those situated more deeply in the chest cavity, hemi-clamshell incisions are used [ 1 , 3 ]. A clamshell incision is the traditional approach when the tumor extends into both hemithoraces [ 3 ].…”

Application of computer‐assisted surgery in pediatric mediastinal tumor surgery

“…Primary mediastinal tumors are relatively rare in children 1 . Most patients with mediastinal tumors typically have a hidden onset and few distinct clinical symptoms at the early stage, so it is easy to miss diagnosis and resulting in huge tumors, which is not conducive to the prognosis of patients 2 . In addition, the child's chest is small, the growth of tumors is very easy to compress the important organs in the chest, which may lead to the respiratory and circulation system dysfunction, thereby endangering the child's life.…”

“…1 Most patients with mediastinal tumors typically have a hidden onset and few distinct clinical symptoms at the early stage, so it is easy to miss diagnosis and resulting in huge tumors, which is not conducive to the prognosis of patients. 2 In addition, the child's chest is small, the growth of tumors is very easy to compress the important organs in the chest, which may lead to the respiratory and circulation system dysfunction, thereby endangering the child's life. Most tumors in children, occur on the mediastinum, whether benign or malignant, such as neurogenic tumors, lymphomas, germ cell tumors, lipomas, thymic tumors, etc., 3 and more than half of the mediastinal tumors are malignant in nature, which need timely clinical treatment.…”