The Role of Minimally Invasive Surgery in the Management of Giant Mediastinal Tumors: a Narrative Review

Overview

Journal Mediastinum

Publisher AME Publishing Company

Date 2022 Dec 30

PMID 36582972

Authors

Maria Rodriguez

Lucia Milla

Jon O Wee

Affiliations

Soon will be listed here.

Abstract

Background And Objective: Beyond diagnosis, minimally invasive surgery has traditionally not been considered suitable for large tumors, those invading vital structures or high-risk patients. However, with the improvement of multimodality treatments able to reduce tumor size preoperatively, patient evaluation and selection, perioperative care (including both surgical and anesthesiological techniques) and postoperative management, the indications of minimally invasive surgery, even in giant mediastinal tumors, have increased and will continue to broaden in future years. This review aims to summarize the existing literature regarding the role of minimally invasive surgery in the management of giant mediastinal tumors. We have focused in the role minimally invasive surgery has in diagnosis and treatment of these tumors and we have tried to provide an updated perspective to identify future applications and work-directions.

Methods: Data regarding minimally invasive surgery in giant mediastinal tumors are limited, including a proper definition of them. We performed a PubMed search of English and Spanish written studies until August 2021.

Key Content And Findings: There is limited data related to minimally invasive surgery in giant mediastinal tumors and much of the literature review we have performed has yielded isolated case reports, case series with a low number of cases or editorials. Although the role of minimally invasive surgery is well consolidated as a diagnostic approach, adequate patient selection, hospital volume and experience, multidisciplinary discussion of candidates, patient safety and adequate oncological resection remain the most important aspects to be taken into account when considering a minimally invasive approach for a giant mediastinal tumor.

Conclusions: With careful and multidisciplinary perioperative planning, minimally invasive surgery has shown to be safe and to provide at least similar outcomes when compared to open approaches in well selected cases. Although data is still limited, improved surgical techniques and available technology will pave the way to increased indications of minimally invasive surgery in giant mediastinal tumors.

Citing Articles

Preoperative Embolization in the Management of Giant Thoracic Tumors: A Case Series.

Lucarelli N, Maggialetti N, Marulli G, Mariani P, Villanova I, Mirabile A J Pers Med. 2024; 14(10).

PMID: 39452527 PMC: 11508663. DOI: 10.3390/jpm14101019.

References

Asai T . Emergency cardiopulmonary bypass in a patient with a mediastinal mass. Anaesthesia. 2007; 62(8):859-60. DOI: 10.1111/j.1365-2044.2007.05210.x. View

Chen K, Zhang X, Jin R, Xiang J, Han D, Zhang Y . Robot-assisted thoracoscopic surgery for mediastinal masses: a single-institution experience. J Thorac Dis. 2020; 12(2):105-113. PMC: 7061195. DOI: 10.21037/jtd.2019.08.105. View

Davis Jr R, OLDHAM Jr H, SABISTON Jr D . Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg. 1987; 44(3):229-37. DOI: 10.1016/s0003-4975(10)62059-0. View

Sihoe A . The evolution of minimally invasive thoracic surgery: implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis. 2014; 6(Suppl 6):S604-17. PMC: 4221337. DOI: 10.3978/j.issn.2072-1439.2014.08.52. View

Li W, van Boven W, Annema J, Eberl S, Klomp H, de Mol B . Management of large mediastinal masses: surgical and anesthesiological considerations. J Thorac Dis. 2016; 8(3):E175-84. PMC: 4805811. DOI: 10.21037/jtd.2016.02.55. View

Sihoe A, Chawla S, Paul S, Nair A, Lee J, Yin K . Technique for delivering large tumors in video-assisted thoracoscopic lobectomy. Asian Cardiovasc Thorac Ann. 2014; 22(3):319-28. DOI: 10.1177/0218492313503641. View

Toker A, Eroglu O, Ziyade S, Tanju S, Senturk M, Dilege S . Comparison of early postoperative results of thymectomy: partial sternotomy vs. videothoracoscopy. Thorac Cardiovasc Surg. 2005; 53(2):110-3. DOI: 10.1055/s-2004-830424. View

Cerfolio R, Bryant A, Minnich D . Operative techniques in robotic thoracic surgery for inferior or posterior mediastinal pathology. J Thorac Cardiovasc Surg. 2012; 143(5):1138-43. DOI: 10.1016/j.jtcvs.2011.12.021. View

Kneuertz P, Kamel M, Stiles B, Lee B, Rahouma M, Nasar A . Robotic Thymectomy Is Feasible for Large Thymomas: A Propensity-Matched Comparison. Ann Thorac Surg. 2017; 104(5):1673-1678. DOI: 10.1016/j.athoracsur.2017.05.074. View

10.

Zirafa C, Melfi F . Robot-assisted surgery for posterior mediastinal mass. J Thorac Dis. 2018; 9(12):4929-4931. PMC: 5756967. DOI: 10.21037/jtd.2017.10.160. View

11.

Kang C, Hwang Y, Lee H, Park I, Kim Y . Robotic Thymectomy in Anterior Mediastinal Mass: Propensity Score Matching Study With Transsternal Thymectomy. Ann Thorac Surg. 2016; 102(3):895-901. DOI: 10.1016/j.athoracsur.2016.03.084. View

12.

Cheng Y, Kao E, Chou S . Videothoracoscopic resection of stage II thymoma: prospective comparison of the results between thoracoscopy and open methods. Chest. 2005; 128(4):3010-2. DOI: 10.1378/chest.128.4.3010. View

13.

Rakovich G, Ferraro P, Therasse E, Duranceau A . Preoperative embolization in the management of a mediastinal paraganglioma. Ann Thorac Surg. 2001; 72(2):601-3. DOI: 10.1016/s0003-4975(00)02293-1. View

14.

Suda T, Nagano H, Kawai H, Hoshikawa Y . Subxiphoid Robot-Assisted Thymectomy With Vascular Prosthetic Replacement. Semin Thorac Cardiovasc Surg. 2019; 32(4):1133-1134. DOI: 10.1053/j.semtcvs.2019.06.007. View

15.

Hartigan P, Ng J, Gill R . Anesthesia in a Patient with a Large Mediastinal Mass. N Engl J Med. 2018; 379(6):587-588. DOI: 10.1056/NEJMc1804797. View

16.

Bodner J, Wykypiel H, Greiner A, Kirchmayr W, Freund M, Margreiter R . Early experience with robot-assisted surgery for mediastinal masses. Ann Thorac Surg. 2004; 78(1):259-65. DOI: 10.1016/j.athoracsur.2004.02.006. View

17.

Zhang H, Chen L, Zheng Y, Wang Z, Geng Y, Wang F . Robot-assisted thymectomy via subxiphoid approach: technical details and early outcomes. J Thorac Dis. 2018; 10(3):1677-1682. PMC: 5906254. DOI: 10.21037/jtd.2018.03.07. View

18.

Anderson D, Dimitrova G, Awad H . Patient with posterior mediastinal mass requiring urgent cardiopulmonary bypass. Anesthesiology. 2011; 114(6):1488-93. DOI: 10.1097/ALN.0b013e31821a8af1. View

19.

Gkouma A . Robotically assisted thymectomy: a review of the literature. J Robot Surg. 2017; 12(1):3-10. DOI: 10.1007/s11701-017-0748-3. View

20.

Ho M, Fleischmann D, Forrester M, Lee D . Coil embolization of a left circumflex feeder branch in a patient with a mediastinal paraganglioma. JACC Cardiovasc Interv. 2011; 4(12):1345-6. DOI: 10.1016/j.jcin.2011.06.021. View