Recent advances in video-assisted thoracoscopic surgery (VATS) have allowed this new surgical technique to be applied to a variety of thoracic diseases. The aim of this study is to clarify the usefulness and indication of the treatment for mediastinal tumors by VATS.PATIENTS AND METHODS: A total of 95 patients underwent resections of mediastinal tumors at our institute between 1993 and 2002. We retrospectively analyzed 37 patients who underwent the VATS procedure for mediastinal tumors. Our indications for VATS were location, size and presumed resectability of the mass without invasion to the adjacent organs on the basis of the preoperative assessment. Twenty-one females and sixteen males ranged in age from 16 to 77 years, with a mean of 52.9 years.
VATS resections were performed by the unilateral thorax approach in all patients. The distribution of anatomical location was 26 anterior, 1 middle, and 10 posterior masses. The average operating time was 85 min (range, 35 to 155). Almost half of these resections were carried out for thymic disease, which included 13 thymomas and 6 thymic cysts. The other mediastinal tumors included 8 neurogenic tumors, 6 teratomas, and 4 bronchogenic cysts. In 33 patients (89.2%), the procedure was completed thoracoscopically. Conversion to thoracotomy was required in two patients due to control the hemorrhage from an intercostal vessel and in two patients due to severe adhesions between the pulmonary structure and the chest wall. Another complication was Horner’s syndrome in one patient. There were no operative or hospital deaths. The follow-up ranges 8 to 116 months and no recurrences have been discovered yet in any patient.CONCLUSIONS: This study showed that VATS was an acceptable method for the therapeutic extirpation of mediastinal tumors, particularly in selected patients and that our operative indication in this series was feasible.
The decision on which approach to use in VATS procedures for mediastinal tumors requires careful assessment of the lesion’s location and proper port placement.
M. Takahama, None.