Abdel Rahman Abdel Rahman M, Sedera Mohamed A, Mourad Ismail A, Aziz Sherif A, Saber Tarek K H, Alsakary Moustafa A
The Department of Surgery, National Cancer Institute Cairo University, Cairo.
J Egypt Natl Canc Inst. 2005 Mar;17(1):1-8.
The incidence of posterior mediastinal tumors relative to all tumors of the mediastinum is 23% to 30%. The posterior mediastinum is a potential space along each side of the vertebral column and adjacent proximal portion of the ribs. Primary tumors of posterior mediastinum are usually neurogenic. The aim of this study was to evaluate different surgical approaches used for the resection of posterior mediastinal tumors, and to assess morbidity, mortality and patients' survival.
Between January 2001 and January 2004, 30 patients with posterior mediastinal tumors were included. CT scan of the chest and CT guided biopsy were done for all patients; whereas MRI was done for suspected intraspinal extension. Posterolateral thoracotomy was the approach used in most of the patients. The Akwari approach was used in most of the patients with Dumbbell tumors.
Neurogenic tumors constituted 67% of cases, being neuroblastoma in 60%. The non neurogenic tumors included a heterogenous group of rare tumors (n=10). Dumbbell tumors were found in 10 patients. Neuroblastoma was the commonest tumor to cause intraspinal extension (40%). Wide local excision was done in 13 patients; whereas extended resection was done in the remaining 17 patients. The mean intra-operative blood loss was 800cc and the mean hospital stay was 12 days. The size of the resected tumor ranged from 3 X 4 cm to 30 X 22 cm, 80% of tumors were malignant. Morbidity in relation to the procedures developed in 8 patients (atelectasis, meningitis, paraplegia, Horner syndrome and mild wound sepsis in 4, 1, 1, 1 and 1 of the patients; respectively). One postoperative mortality, due to meningitis was recorded. The overall survival by the end of three years was 87.7% with a mean survival of 30.4 months. The overall disease free survival was 55.9% with a mean disease free survival of 26.2 months.
Posterior mediastinal tumors may reach large size before becoming symptomatic. Complete surgical excision (including adjacent invaded organs) mainly by open technique should be the rule for these patients as there is survival benefit. Great care should be taken when dealing with Dumbbell tumors.
后纵隔肿瘤在所有纵隔肿瘤中的发生率为23%至30%。后纵隔是沿脊柱两侧及相邻肋骨近端的一个潜在间隙。后纵隔原发性肿瘤通常为神经源性。本研究的目的是评估用于切除后纵隔肿瘤的不同手术方法，并评估发病率、死亡率和患者生存率。
2001年1月至2004年1月期间，纳入30例后纵隔肿瘤患者。所有患者均行胸部CT扫描及CT引导下活检；疑似脊髓内侵犯者行MRI检查。大多数患者采用后外侧开胸手术。大多数哑铃形肿瘤患者采用阿克瓦里手术入路。
神经源性肿瘤占病例的67%，其中神经母细胞瘤占60%。非神经源性肿瘤包括一组异质性罕见肿瘤（n = 10）。10例患者发现哑铃形肿瘤。神经母细胞瘤是导致脊髓内侵犯最常见的肿瘤（40%）。13例患者行广泛局部切除；其余17例患者行扩大切除。术中平均失血量为800cc，平均住院时间为12天。切除肿瘤大小范围为3×4cm至30×22cm，80%的肿瘤为恶性。8例患者出现与手术相关的并发症（肺不张、脑膜炎、截瘫、霍纳综合征和轻度伤口感染，分别发生在4例、1例、1例、1例和1例患者中）。记录到1例术后因脑膜炎死亡。三年末的总生存率为87.7%，平均生存时间为30.4个月。总的无病生存率为55.9%，平均无病生存时间为26.2个月。
后纵隔肿瘤在出现症状前可能已长得很大。对于这些患者，主要通过开放技术进行完整的手术切除（包括相邻受侵犯器官）应为常规做法，因为这对生存有益。处理哑铃形肿瘤时应格外小心。
