SURGERY FOR INVASIVE PRIMARY MEDIASTINAL TUMORS

Background. There have been few reports on results after extended radi cal resection for primary mediastinal tumors invading neighboring orga ns. Methods. A retrospective analysis of 89 patients who underwent tot al or subtotal resection of a primary mediastinal tumor with resection of at least part of an adjacent structure between 1979 and 1995 was p erformed. Clinical data were collected from the medical records. Resul ts, There were 35 invasive thymomas, 12 thymic carcinomas, 17 germ cel l tumors, 16 lymphomas, 3 neurogenic tumors, 3 thyroid carcinomas, 2 r adiation-induced sarcomas, and 1 mediastinal mesothelioma. The tumor w as located in the anterior mediastinum in 74% of patients. Residual ma sses after chemotherapy were excised in 14 patients with germ cell tum or and 8 with lymphoma. A median sternotomy was the most frequentIy us ed approach (79% of patients), Total resection was achieved in 79% and significantly improved survival (p < 0.01). Adjacent resected structu res included 38 phrenic nerves, 21 superior venae cavae, 16 upper lobe s, and 13 innominate veins, in 5 patients, a pneumonectomy was require d. The complication rate was 17% and the mortality rate, 6%. With foll ow-up available for 86 patients, the overall 5-year survival rate was 69% for patients with thymoma, 42% for patients with thymic carcinoma, 48% for patients with germ cell tumor, and 83% for patients with lymp homa. Conclusions. Malignant mediastinal tumors can be safely resected even if they have invaded other mediastinal structures. Complete rese ction is important to achieve satisfactory long-term survival. A media n sternotomy is an excellent approach, and a preoperative diagnosis by biopsy is desirable. Residual masses after chemotherapy for lymphoma or germ cell tumor should be resected. Extensive resection without a p reoperative diagnosis is not indicated. (Ann Thorac Surg 1998;66:234-9 ). (C) 1998 by The Society of Thoracic Surgeons.