Surgery for invasive primary mediastinal tumors

Our plain-English summary of Surgery for invasive primary mediastinal tumors, by E.A. Bacha, A.R. Chapelier, P. Macchiarini, et al (The Annals of Thoracic Surgery, 1998).

The study

• Authors: E.A. Bacha, A.R. Chapelier, P. Macchiarini, E. Fadel, P.G. Dartevelle
• Journal: The Annals of Thoracic Surgery
• Published: 1998;66(1):234-9
• Cited by: 75 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: There have been few reports on results after extended radical resection for primary mediastinal tumors invading neighboring organs.

Methods: A retrospective analysis of 89 patients who underwent total or subtotal resection of a primary mediastinal tumor with resection of at least part of an adjacent structure between 1979 and 1995 was performed. Clinical data were collected from the medical records.

Results: There were 35 invasive thymomas, 12 thymic carcinomas, 17 germ cell tumors, 16 lymphomas, 3 neurogenic tumors, 3 thyroid carcinomas, 2 radiation-induced sarcomas, and 1 mediastinal mesothelioma. The tumor was located in the anterior mediastinum in 74% of patients. Residual masses after chemotherapy were excised in 14 patients with germ cell tumor and 8 with lymphoma. A median sternotomy was the most frequently used approach (79% of patients). Total resection was achieved in 79% and significantly improved survival (p < 0.01). Adjacent resected structures included 38 phrenic nerves, 21 superior venae cavae, 16 upper lobes, and 13 innominate veins, in 5 patients, a pneumonectomy was required. The complication rate was 17% and the mortality rate, 6%. With follow-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 lymphoma.

Conclusions: Malignant mediastinal tumors can be safely resected even if they have invaded other mediastinal structures. Complete resection is important to achieve satisfactory long-term survival. A median 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 preoperative diagnosis is not indicated.

In plain English

This was a review of patient records from one surgical department in Le Plessis-Robinson, France. It covered 89 patients operated on between November 1979 and December 1995 for cancers starting in the mediastinum (the space between the lungs) that had grown into nearby structures. Thymomas were the most common (35 patients), followed by germ cell tumors (17), lymphomas (16) and thymic carcinomas (12). One patient had a mesothelioma arising from the mediastinal pleura. The article does not mention asbestos; two tumors were radiation-induced sarcomas. The tumor was fully removed in 79% of patients, who had significantly better survival. Complications occurred in 17% of patients, and 6% died shortly after surgery. At five years, an estimated 63% of all patients were alive. By tumor type, the figures were 69% for thymoma, 42% for thymic carcinoma, 48% for germ cell tumors and 83% for lymphoma. The authors concluded that these tumors can be removed safely even after invading nearby structures. They also concluded that complete removal matters for long-term survival and that extensive surgery without a prior diagnosis is not indicated.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of one institution's surgical case series
• Who was studied: 89 patients (33 female, 56 male; aged 2.5 to 83 years, average 42) with invasive primary mediastinal tumors. All had surgery at Centre Chirurgical Marie-Lannelongue, France, from November 1979 to December 1995. All had tumor invasion of one or more mediastinal structures and needed at least part of a neighboring structure removed.
• Exposure: Not an exposure study. The study examined extended surgical removal of invasive mediastinal tumors. Asbestos is not mentioned, including for the one mesothelioma patient. Two tumors were described as radiation-induced sarcomas.
• Main results:
  • Tumor types among the 89 patients: 35 invasive thymomas, 12 thymic carcinomas, 17 germ cell tumors and 16 lymphomas. The remainder were other tumors.
  • One patient had a mediastinal mesothelioma. The article does not report this patient's outcome separately.
  • The tumor was removed completely in 79% of patients. Complete removal was associated with significantly better survival (p less than 0.01).
  • Blood vessels were removed in 36 patients (40%), including replacement of the superior vena cava in 21 patients.
  • 15 of the 89 patients (17%) had surgical complications.
  • 5 of the 89 patients (6%) died in the immediate postoperative period.
  • The estimated 5-year survival rate for all patients was 63%. Follow-up was available for 86 patients.
  • 5-year survival by tumor type: thymoma 69%, thymic carcinoma 42%, germ cell tumors 48%, lymphoma 83%.
• The authors' conclusion: The authors concluded that malignant mediastinal tumors can be removed safely even after invading nearby structures, and that complete removal is important for long-term survival. They also concluded that extensive surgery without a diagnosis made before the operation is not indicated.
• Limitations the authors state:
  • In the early years of this historical series, chemotherapy before surgery was underused.
  • The authors said the favorable overall survival may partly reflect a higher number of less aggressive thymomas in their series.

Topics

Medical terms in this study, explained in our Lexicon: Carcinoma, Germ Cell Tumor, Sarcoma, Mesothelioma, Mediastinum, Chemotherapy, Pneumonectomy, Mediastinal Structures.

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