Hwang Su Kyung, Park Seung-Il, Kim Yong-Hee, Kim Hyeong Ryul, Choi Se Hoon, Kim Dong Kwan
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
Surg Endosc. 2016 Sep;30(9):4065-8. doi: 10.1007/s00464-015-4721-9. Epub 2015 Dec 22.
In patients with a mediastinal tumor, video-assisted thoracic surgery (VATS) is considered to be associated with more postoperative advantages compared to open procedures. However, open procedures are still preferred in cases with large or malignant tumors. Therefore, in order to determine the appropriate surgical strategies for resection of teratomas, we here review our experience with such cases.
Between January 2000 and February 2014, we experienced 132 patients diagnosed with mediastinal teratoma. By using data from a retrospective review of the patients' medical records, we compared the demographic characteristics, hospital stay duration, chest tube indwelling time, operative time, and mass size of the VATS group with those of the patients in the open group. Moreover, we also analyzed the postoperative complications and recurrence. Finally, based on our findings, we created a '∆V (volume of the mass-volume of the cyst in the mass)' capable of determining the appropriate surgical strategy, measured by preoperative computed tomography scan.
We excised the mass using VATS in 79 patients, while 53 patients underwent open procedures, including thoracotomy (n = 10) and median sternotomy (n = 43). The operative times, the hospital stay duration, and the chest tube indwelling time were significantly shorter in the VATS group compared to in the open group (Table 1). Four cases were converted to thoracotomy. The mean mass sizes were 6.53 ± 2.20 cm and 8.58 ± 3.45 cm in the VATS and open groups, respectively. The '∆V' of the VATS group was higher than that of the open group. There were three postoperative complications. Table 1 Comparison of the perioperative variables between the VATS group and open groups VATS (n = 79) Open (n = 53) p value Preoperative variables Age (years) 32.34 ± 13.44 29.30 ± 14.76 0.223 Female 63 28 0.001 BMI 22.07 ± 3.34 22.59 ± 3.91 0.409 ASA class 0.272 Class 1 39 21 Class 2 40 32 Mass size (cm) 6.53 ± 2.20 8.58 ± 3.45 <0.001 ∆V (cm(3)) 988.15 ± 1590.85 3093.22 ± 4947.33 0.001 Intraoperative variable Operative time (min) 129 ± 46 170 ± 45 <0.001 Postoperative variable Hospitalization (days) 6.00 ± 3.03 8.94 ± 3.99 <0.001 ICU stay (days) 0 0.42 ± 0.50 <0.001 CTD time (days) 2.00 ± 1.24 3.8 ± 3.63 <0.001 Median F/U duration (months) 47.16 ± 43.60 27.52 ± 34.00 The data are presented as mean ± standard deviation VATS video-assisted thoracic surgery, CTD chest tube indwelling
VATS for mediastinal teratoma can be performed safely in selected patients with large or malignant masses. The proposed '∆V' appears to be a useful method for determining the appropriate surgical strategy in the large size teratoma cases.
对于纵隔肿瘤患者，与开放手术相比，电视辅助胸腔镜手术（VATS）被认为具有更多术后优势。然而，对于大型或恶性肿瘤病例，仍首选开放手术。因此，为了确定畸胎瘤切除术的合适手术策略，我们在此回顾我们在这类病例中的经验。
2000年1月至2014年2月期间，我们诊治了132例诊断为纵隔畸胎瘤的患者。通过回顾性分析患者病历数据，我们比较了VATS组和开放手术组患者的人口统计学特征、住院时间、胸管留置时间、手术时间和肿块大小。此外，我们还分析了术后并发症和复发情况。最后，根据我们的研究结果，我们创建了一个“∆V（肿块体积 - 肿块内囊肿体积）”，通过术前计算机断层扫描测量，能够确定合适的手术策略。
我们对79例患者采用VATS切除肿块，而53例患者接受了开放手术，包括开胸手术（n = 10）和正中胸骨切开术（n = 43）。与开放手术组相比，VATS组的手术时间、住院时间和胸管留置时间明显更短（表1）。4例转为开胸手术。VATS组和开放手术组的平均肿块大小分别为6.53 ± 2.20 cm和8.58 ± 3.45 cm。VATS组的“∆V”高于开放手术组。有3例术后并发症。表1 VATS组和开放手术组围手术期变量比较 VATS（n = 79） 开放手术（n = 53） p值 术前变量 年龄（岁） 32.34 ± 13.44 29.30 ± 14.76 0.223 女性 63 28 0.001 BMI 22.07 ± 3.34 22.59 ± 3.91 0.409 ASA分级 0.272 1级 39 21 2级 40 32 肿块大小（cm） 6.53 ± 2.20 8.58 ± 3.45 <0.001 ∆V（cm³） 988.15 ± 1590.85 3093.22 ± 4947.33 0.001 术中变量 手术时间（分钟） 129 ± 46 170 ± 45 <0.001 术后变量 住院时间（天） 6.00 ± 3.03 8.9
