The challenging spectrum of mediastinal lesions and their surgical approach: Insights from a single-center experience

Ahmed  Abdelaziz; Nora Mamdouh; Ahmed  Tarek; Akram  Allam; Ahmed Saad

Ahmed Abdelaziz Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Nora Mamdouh Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Ahmed Tarek Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Akram Allam Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Ahmed Saad Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Keywords: Mediastinum, Video-assisted thoracoscopic surgery, Mediastinal masses, Mediastinal tumors, Mediastinal cysts, Echocardiography

Abstract

Background: Mediastinal masses represent a wide variety of pathologies. It occurs in both adults and pediatrics, and many of them are discovered incidentally. The difficult anatomical access for these lesions and their relation to important anatomical structures make diagnosis and treatment a challenge. In this study, we aimed to highlight and describe different pathologies and surgical approaches to these lesions, and to shed light on these important, challenging surgeries and the related morbidity and mortality.

Methods: We retrospectively reviewed the medical records for patients with mediastinal masses under our service between August 2020 and August 2023. Data collected included: age, sex, indication of surgery, approach, role of surgery, definitive pathology, operative time, length of hospital stay, and complications.

Results: A Total of 61 cases were included, 39 females and 22 males, with mean age 31.4 years. The mean operative time was 127.4 minutes (127.4 ± 48.0); mean hospital stay was 3.64 days (3.64 ± 4.89). The complication rate was 21.3% and perioperative mortality was 4.9%.

Conclusion: The wide spectrum of mediastinal pathologies is a challenge every time in decision-making for thoracic surgeons. The choice of surgical approach should be tailored for each case. Open surgery is still the gold standard for large or invasive lesions. Yet minimally invasive video-assisted thoracoscopic and robotic surgery has recently proven safety and efficacy for biopsies and complete resection of mediastinal masses, in selected cases treated by an experienced team.