Ricci C, Rendina E A, Venuta F, Pescarmona E O, Di Tolla R, Ruco L P, Guglielmi C, Anselmo A P, Mandelli F
Department of Thoracic Surgery, University La Sapienza, Rome, Italy.
J Thorac Cardiovasc Surg. 1990 Apr;99(4):691-5.
With the aim of assessing the role of surgery in the management of isolated mediastinal lymphoma, we have reviewed the data of 123 operations performed on 102 patients (64 with Hodgkin's disease and 38 with non-Hodgkin's lymphoma). One death and four major complications occurred in these patients. Macroscopically radical resection was performed in 14 patients who are free of disease after 1 to 14 years. Debulking resection was performed in five patients: Three are alive after 5 to 11 years and two died after 36 and 40 months. Ten patients (seven with non-Hodgkin's lymphoma and three with Hodgkin's disease) had residual mediastinal masses of more than 2 cm after chemotherapy; to assess the nature of the lesion (fibrosis or residual disease), we subjected these patients to surgical restaging of the mediastinum: Results were negative in seven and positive in three. We conclude that open biopsy is indispensable to obtain good tissue specimens suitable for histologic and immunohistochemical assessment. Biopsy must be performed as a major surgical procedure to avoid reoperation: Mediastinoscopy and sternal splitting incisions proved the most reliable approaches. Locally radical or debulking resection might be considered in selected cases to enhance long-term results.
为了评估手术在孤立性纵隔淋巴瘤治疗中的作用，我们回顾了102例患者接受的123例手术数据（64例霍奇金病患者和38例非霍奇金淋巴瘤患者）。这些患者中发生了1例死亡和4例严重并发症。14例患者进行了宏观上的根治性切除，术后1至14年无疾病。5例患者进行了减瘤切除：3例在5至11年后存活，2例在36个月和40个月后死亡。10例患者（7例非霍奇金淋巴瘤患者和3例霍奇金病患者）化疗后纵隔残留肿块大于2 cm；为了评估病变的性质（纤维化或残留疾病），我们对这些患者进行了纵隔手术分期：7例结果为阴性，3例结果为阳性。我们得出结论，开放活检对于获得适合组织学和免疫组化评估的良好组织标本是必不可少的。活检必须作为一项主要手术操作进行，以避免再次手术：纵隔镜检查和胸骨劈开切口被证明是最可靠的方法。在某些选定的病例中，可以考虑进行局部根治性或减瘤切除，以提高长期疗效。
