MULTICENTER VATS EXPERIENCE WITH MEDIASTINAL TUMORS

Background. The use of video-assisted thoracic surgery for diagnosis a nd treatment of mediastinal tumors in a multiinstitution patient popul ation is not well understood. Methods. We studied 48 cases from Cancer and Leukemia Group B thoracic surgeons. Of 21 men and 27 women, aged 41 +/- 16 years, 22 patients were asymptomatic. In the others, 92% of tumor-related symptoms improved or resolved after treatment. Five tumo rs involved the anterior compartment, 19 the middle, and 24 the poster ior compartment. Diagnoses were typical for each compartment but also included uncommon problems such as superior vena cava hemangioma and a histoplasmosis cyst causing hoarseness. Of the lesions, a biopsy of 1 2 was done without excision and the rest were excised completely. Fift een were cystic and 10 were malignant (8 biopsy only). Maximal dimensi ons were 5.2 +/- 3.3 cm. Results. Operations were briefer for 24 poste rior (93 +/- 41 min) than 5 anterior (195 +/- 46 min, p < 0.01) or 19 middle mediastinal tumors (170 +/- 78 min, p < 0.01). Although 96% had vital mediastinal relations, only six open conversions were performed because of bleeding (n = 3), large size, impaired exposure, or rib at tachments, and no patient had morbidity beyond that expected for the t horacotomy. Postoperative stay was shorter for the nonconversion group (3.2 +/- 2.8 versus 5.5 +/- 2.1 days, p = 0.05), as was chest tube du ration (1.7 +/- 1.4 days versus 3.2 +/- 1.9 days, p = 0.03). There wer e no postoperative deaths or major complications, but 7 patients had m inor complications. During a mean of 20 months of surveillance (range, 1 to 52 months), one cyst recurred (asymptomatic) as did one sarcoma that was excised. Conclusions. Video-assisted thoracic surgery is a sa fe technique for benign mediastinal tumors, typically those in the mid dle and posterior mediastinum. (Ann Thorac Surg 1998;66:187-92) (C) 19 98 by The Society of Thoracic Surgeons.