Araştırma Makalesi
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Anterior Mediastinal Kitlelere Cerrahi Yaklaşım

Yıl 2019, Cilt: 3 Sayı: 2, 154 - 158, 23.08.2019
https://doi.org/10.30565/medalanya.555611

Öz

Amaç: Anterior mediastinal kitle tanısı ile ameliyat edilen vakaların klinik seyrini, cerrahi yaklaşım tiplerini ve erken dönem sonuçlarını incelenmesi amaçlandı. 

Hastalar ve Yöntemler: 2014 – 2019 yılları arasında anterior mediastinal kitle tanısı ile ameliyat edilen 25 olgu retrospektif olarak incelendi. Hastaların yaşı, cinsiyeti, prezente eden semptomları, preoperatif radyolojik değerlendirmeleri ve cerrahi teknikler kaydedildi. Sekizi erkek, 17 ‘i kadın toplam 25 hastanın yaşları 18-89 arasında değişmekte olup ortalama 44,4± 16,9 yıl idi. 

Bulgular: En sık izlenen semptom göğüs ağrısı (%90) ve öksürük (%50) olduğu gözlendi. En sık gözlenen patolojik tanılar timik tümörler (n=14, %56,0) ve lenfoma (n=5,%20,0) olarak belirlendi. Uygulanan cerrahi yaklaşım 16 hastada median sternotomi, beş hastada parsiyel sternotomi ve dört hastada VATS (Video Assisted Thoracic Surgery) idi. Postoperatif ölüm veya majör komplikasyon gözlenmemekle birlikte sekiz hastada minör komplikasyonlar gelişti. Ortalama cerrahi sonrası hastanede kalış süresi 5±5,2 gün idi. 













Sonuç: Anterior mediasten kitlelerin tanı ve tedavisinde cerrahi yaklaşım güvenle uygulanabilen temel bir yöntemdir. 

Kaynakça

  • 1. Laurent F, Latrabe V, Lecesne R, Zennaro H, Airaud JY, Rauturier JF, et al. Mediastinal masses: Diagnostic approach. Eur Radiol 1998;8:1148–59. doi:10.1007/s003300050525.
  • 2. Strollo DC, Rosado De Christenson ML, Jett JR. Primary mediastinal tumors. Part 1: Tumors of the anterior mediastinum. Chest 1997;112:511–22. doi:10.1378/chest.112.2.511.
  • 3. Marchevsky A, Marx A, Strobel P, Suster S, Venuta F, Marino M, et al. Policies and reporting guidelines for small biopsy specimens of mediastinal masses. Chinese J Lung Cancer 2014;17:104–9. doi:10.3779/j.issn.1009-3419.2014.02.07.
  • 4. James M. Donahue and Francis C. Nichols. Primary Mediastinal Tumors and Cysts and Diagnostic Investigation of Mediastinal Masses. In: Shields TW, LoCicero J III RCF, editor. Gen. Thorac. Surg. 7th ed., Lippincott Williams and Wilkins; 2009, p. 2195–201.
  • 5. Ferguson MK, Lee E, Skinner DB, Little AG. Selective Operative Approach for Diagnosis and Treatment of Anterior Mediastinal Masses. Ann Thorac Surg 1987;44:583–6. doi:10.1016/S0003-4975(10)62139-X.
  • 6. Merrick HW, Martin JT, Woldenberg LEES. Massive lntraoperative Atelectasis Secondary to U nt reated Mediast inal Hodgkin ’ s Disease : Report of the Hazard and Review of the Literature. J Surg Oncol 1989;64:60–4.
  • 7. Carter BW, Marom EM, Detterbeck FC. Approaching the patient with an anterior mediastinal mass: A guide for clinicians. J Thorac Oncol 2014;9:S102–9. doi:10.1097/JTO.0000000000000294.
  • 8. Mullen B, Richardson JD. Primary Anterior Mediastinal Tumors in Children and Adults. Ann Thorac Surg 1986;42:338–45. doi:10.1016/S0003-4975(10)62751-8.
  • 9. Tomaszek S, Wigle DA, Keshavjee S, Fischer S. Thymomas: Review of Current Clinical Practice. Ann Thorac Surg 2009;87:1973–80. doi:10.1016/j.athoracsur.2008.12.095.
  • 10. Ettinger DS, Riely GJ, Akerley W, Borghaei H, Chang AC, Cheney RT, et al. Thymomas and Thymic Carcinomas Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw 2013;11:562–76. doi:10.6004/JNCCN.2013.0072.
  • 11. Marchevsky A, Marx A, Strobel P, Suster S, Venuta F, Marino M, et al. Policies and reporting guidelines for small biopsy specimens of mediastinal masses. J Thorac Oncol 2014;17:104–9. doi:10.3779/j.issn.1009-3419.2014.02.07.
  • 12. Zhang S, Gao H, Wang XA, Liang B, Li DW, Shao Y, et al. Primary choriocarcinoma in mediastinum with multiple lung metastases in a male patient: A case report and a review of the literature. Thorac Cancer 2014;5:463–7. doi:10.1111/1759-7714.12120.
  • 13. Fry MGB and WA. Thoracic Incisions. In: Shields TW, LoCicero J III, Reed CE FR, editor. Gen. Thorac. Surg. 7th ed., Lippincott Williams and Wilkins; 2009, p. 397–401.
  • 14. Toker A, Sone J, Zielinski M, Rea F, Tomulescu V, Deerbeck FC. Standard terms, definitions, and policies for minimally invasive resection of thymoma. Chinese J Lung Cancer 2014;17:90–4. doi:10.3779/j.issn.1009-3419.2014.02.05.
  • 15. Pennathur A, Qureshi I, Schuchert MJ, Dhupar R, Ferson PF, Gooding WE, et al. Comparison of surgical techniques for early-stage thymoma: Feasibility of minimally invasive thymectomy and comparison with open resection. J Thorac Cardiovasc Surg 2011;141:694–700. doi:10.1016/j.jtcvs.2010.09.003.
  • 16. Limmer KK, Kernstine KH. Minimally Invasive and Robotic-Assisted Thymus Resection. Thorac Surg Clin 2011;21:69–83. doi:10.1016/j.thorsurg.2010.08.005.
  • 17. Li WWL, Van Boven WJP, Annema JT, Eberl S, Klomp HM, de Mol BAJM. Management of large mediastinal masses: Surgical and anesthesiological considerations. J Thorac Dis 2016;8:E175–84. doi:10.21037/jtd.2016.02.55.
  • 18. Ahmet A. Systematic Reviews and Meta-Analyses Acta Med. Alanya 2018;2(2):62-63. [Turkish] DOI: 10.30565/medalanya.439541

Surgical Approach to Anterior Mediastinal Masses

Yıl 2019, Cilt: 3 Sayı: 2, 154 - 158, 23.08.2019
https://doi.org/10.30565/medalanya.555611

Öz

Aim: The aim of this study was to evaluate the clinical progress, type of surgical approach and early results of resection of anterior mediastinal masses. 

Patients and Methods: We retrospectively reviewed the reports of 25 patients who underwent surgery for an anterior mediastinal mass between 2014 and 2019. Patients’ age, gender, presenting symptoms, preoperative radiological investigations and surgical techniques were recorded. There were eight male and 17 female patients, and their age ranged from 18-89 with a mean of 44.4± 16.9 years. 

Results: The most frequent presenting symptoms were chest pain (90%) and cough (50%). The most common pathological diagnoses were thymic tumors (n=14, 56%) and lymphoma (n=5, 20%). Surgical approaches applied were median sternotomy in 16 patients, partial sternotomy in five patients and VATS (Video Assisted Thoracic Surgery) in four patients. There were no postoperative deaths or major complications, but eight patients had minor complications. Postoperative stay was 5±5.2 days. 













Conclusion:Surgery is a safe technique for diagnosis and treatment of anterior mediastinal masses. 

Kaynakça

  • 1. Laurent F, Latrabe V, Lecesne R, Zennaro H, Airaud JY, Rauturier JF, et al. Mediastinal masses: Diagnostic approach. Eur Radiol 1998;8:1148–59. doi:10.1007/s003300050525.
  • 2. Strollo DC, Rosado De Christenson ML, Jett JR. Primary mediastinal tumors. Part 1: Tumors of the anterior mediastinum. Chest 1997;112:511–22. doi:10.1378/chest.112.2.511.
  • 3. Marchevsky A, Marx A, Strobel P, Suster S, Venuta F, Marino M, et al. Policies and reporting guidelines for small biopsy specimens of mediastinal masses. Chinese J Lung Cancer 2014;17:104–9. doi:10.3779/j.issn.1009-3419.2014.02.07.
  • 4. James M. Donahue and Francis C. Nichols. Primary Mediastinal Tumors and Cysts and Diagnostic Investigation of Mediastinal Masses. In: Shields TW, LoCicero J III RCF, editor. Gen. Thorac. Surg. 7th ed., Lippincott Williams and Wilkins; 2009, p. 2195–201.
  • 5. Ferguson MK, Lee E, Skinner DB, Little AG. Selective Operative Approach for Diagnosis and Treatment of Anterior Mediastinal Masses. Ann Thorac Surg 1987;44:583–6. doi:10.1016/S0003-4975(10)62139-X.
  • 6. Merrick HW, Martin JT, Woldenberg LEES. Massive lntraoperative Atelectasis Secondary to U nt reated Mediast inal Hodgkin ’ s Disease : Report of the Hazard and Review of the Literature. J Surg Oncol 1989;64:60–4.
  • 7. Carter BW, Marom EM, Detterbeck FC. Approaching the patient with an anterior mediastinal mass: A guide for clinicians. J Thorac Oncol 2014;9:S102–9. doi:10.1097/JTO.0000000000000294.
  • 8. Mullen B, Richardson JD. Primary Anterior Mediastinal Tumors in Children and Adults. Ann Thorac Surg 1986;42:338–45. doi:10.1016/S0003-4975(10)62751-8.
  • 9. Tomaszek S, Wigle DA, Keshavjee S, Fischer S. Thymomas: Review of Current Clinical Practice. Ann Thorac Surg 2009;87:1973–80. doi:10.1016/j.athoracsur.2008.12.095.
  • 10. Ettinger DS, Riely GJ, Akerley W, Borghaei H, Chang AC, Cheney RT, et al. Thymomas and Thymic Carcinomas Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw 2013;11:562–76. doi:10.6004/JNCCN.2013.0072.
  • 11. Marchevsky A, Marx A, Strobel P, Suster S, Venuta F, Marino M, et al. Policies and reporting guidelines for small biopsy specimens of mediastinal masses. J Thorac Oncol 2014;17:104–9. doi:10.3779/j.issn.1009-3419.2014.02.07.
  • 12. Zhang S, Gao H, Wang XA, Liang B, Li DW, Shao Y, et al. Primary choriocarcinoma in mediastinum with multiple lung metastases in a male patient: A case report and a review of the literature. Thorac Cancer 2014;5:463–7. doi:10.1111/1759-7714.12120.
  • 13. Fry MGB and WA. Thoracic Incisions. In: Shields TW, LoCicero J III, Reed CE FR, editor. Gen. Thorac. Surg. 7th ed., Lippincott Williams and Wilkins; 2009, p. 397–401.
  • 14. Toker A, Sone J, Zielinski M, Rea F, Tomulescu V, Deerbeck FC. Standard terms, definitions, and policies for minimally invasive resection of thymoma. Chinese J Lung Cancer 2014;17:90–4. doi:10.3779/j.issn.1009-3419.2014.02.05.
  • 15. Pennathur A, Qureshi I, Schuchert MJ, Dhupar R, Ferson PF, Gooding WE, et al. Comparison of surgical techniques for early-stage thymoma: Feasibility of minimally invasive thymectomy and comparison with open resection. J Thorac Cardiovasc Surg 2011;141:694–700. doi:10.1016/j.jtcvs.2010.09.003.
  • 16. Limmer KK, Kernstine KH. Minimally Invasive and Robotic-Assisted Thymus Resection. Thorac Surg Clin 2011;21:69–83. doi:10.1016/j.thorsurg.2010.08.005.
  • 17. Li WWL, Van Boven WJP, Annema JT, Eberl S, Klomp HM, de Mol BAJM. Management of large mediastinal masses: Surgical and anesthesiological considerations. J Thorac Dis 2016;8:E175–84. doi:10.21037/jtd.2016.02.55.
  • 18. Ahmet A. Systematic Reviews and Meta-Analyses Acta Med. Alanya 2018;2(2):62-63. [Turkish] DOI: 10.30565/medalanya.439541
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Muharrem Özkaya 0000-0002-3507-1349

Nilay Çavuşoğlu Bu kişi benim 0000-0002-0675-9267

Yayımlanma Tarihi 23 Ağustos 2019
Gönderilme Tarihi 18 Nisan 2019
Kabul Tarihi 24 Mayıs 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 3 Sayı: 2

Kaynak Göster

Vancouver Özkaya M, Çavuşoğlu N. Surgical Approach to Anterior Mediastinal Masses. Acta Med. Alanya. 2019;3(2):154-8.

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