Three different surgical methods for large-sized anterior mediastinal tumors in real-world practice

Abstract

Abstract Background Video-assisted thoracoscopic surgery (VATS) for a relatively large mediastinal tumor (5.0–10.0 cm) remains controversial. In addition, few studies have focused on comparing different surgical approaches for large mediastinal tumors. Therefore, this study aimed to compare the short-term outcomes between subxiphoid approach VATS, intercostal approach VATS, and traditional sternotomy for large-sized anterior mediastinal tumors. Methods The study consecutively enrolled 159 patients with large-sized anterior mediastinal tumors (5.0–10.0 cm) who received surgery in our hospital between January 2018 and July 2022 (subxiphoid approach VATS: 52 patients, intercostal approach VATS: 70 patients, traditional sternotomy: 37 patients). We analyzed the clinical baseline data, intraoperative and postoperative outcomes, and postoperative complications of all patients. Then the patients were further divided into two groups according to whether there was a peripheral organ (such as pericardium, lung, or left innominate vein) invasion: group A, invasion of the surrounding organ, and group B, no invasion of the surrounding organ. Intraoperative and postoperative outcomes and postoperative complications were also analyzed in group A and group B, respectively. Results In all patients, there were significant differences in blood loss (subxiphoid approach: 33.1 ± 46.0 ml, intercostal approach: 36.9 ± 44.1 ml, sternotomy: 113.0 ± 84.9 ml, P < 0.001) and duration of postoperative oral analgesics (subxiphoid approach: 3.4 ± 0.9 d, intercostal approach: 3.7 ± 1.4 d, sternotomy: 4.5 ± 1.5 d, P = 0.002) among the three methods. In group A, there was a significant difference in blood loss (subxiphoid approach: 50.0 ± 67.7 ml, intercostal approach: 90.0 ± 66.6 ml, sternotomy: 157.9 ± 90.2 ml, P < 0.001) among the three methods. In group B, there were significant differences in the duration of postoperative oral analgesics (subxiphoid approach: 3.2 ± 0.8 d, intercostal approach: 3.7 ± 1.4 d, sternotomy: 4.2 ± 1.1 d, P < 0.05) and blood loss (subxiphoid approach: 22.5 ± 19.3 ml, intercostal approach: 31.9 ± 38.5 ml, sternotomy: 65.6 ± 44.9 ml, P < 0.001) between the three methods. There were no significant differences in the postoperative complications. Conclusions VATS is an effective, minimally invasive, and safe procedure for large-sized anterior mediastinal tumors (5.0–10.0 cm) without an invasion of the surrounding organs, and maybe a feasible and secure method for large-sized anterior mediastinal tumors with an invasion of the surrounding organ (such as the pericardium, lung, or left innominate vein). Subxiphoid approach VATS is a less invasive procedure than intercostal approach VATS and traditional sternotomy due to its reduced blood loss and postoperative pain.

Keywords

• Large-sized anterior mediastinal tumor
• Traditional sternotomy
• Subxiphoid approach video-assisted thoracoscopic surgery
• Intercostal approach video-assisted thoracoscopic surgery