Moscarelli Marco, Rahouma Mohamed, Nasso Giuseppe, di Bari Nicola, Speziale Giuseppe, Bartolomucci Francesco, Pepe Martino, Fattouch Khalil, Lau Christopher, Gaudino Mario
Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy.
Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
J Card Surg. 2021 Feb;36(2):483-492. doi: 10.1111/jocs.15224. Epub 2020 Dec 1.
Cardiac tumors are rare conditions. The vast majority of them are benign yet they may lead to serious complications. Complete surgical resection is the gold standard treatment and should be performed as soon as the diagnosis is made. Median sternotomy (MS) is the standard approach and provides excellent early outcomes and durable results at follow-up. However, minimally invasive (MI) is gaining popularity and its role in the treatment of cardiac tumors needs further clarification.
A systematic literature review identified 12 candidate studies; of these, 11 met the meta-analysis criteria. We analyzed outcomes of 653 subjects (294 MI and 359 MS) with random effects modeling. Each study was assessed for heterogeneity. The primary endpoints were mortality at follow-up and tumor relapse. Secondary endpoints included relevant intraoperative and postoperative outcomes; tumor size was also considered.
There were no significant between-group differences in terms of late mortality (incidence rate ratio [IRR]: MI vs. MS, 0.98 [95% confidence interval [CI]: 0.25-3.82], p = .98). Few relapses (IRR: 1.13; CI: 0.26-4.88; p = .87) and redo surgery (IRR: 1.92; 95% CI: 0.39-9.53; p = .42) were observed in both groups; MI approach resulted in prolonged operation time but that did not influence the clinical outcomes. Tumor size did not significantly differ between groups.
Both MI and MS are associated with excellent early and late outcomes with acceptable survival rate and low incidence of recurrences. This study confirms that cardiac tumor may be approached safely and radically with a MI approach.
心脏肿瘤较为罕见。其中绝大多数为良性，但仍可能导致严重并发症。完整的手术切除是金标准治疗方法，一旦确诊应立即进行。正中胸骨切开术（MS）是标准术式，早期效果良好，随访结果持久。然而，微创（MI）手术正越来越受欢迎，其在心脏肿瘤治疗中的作用需要进一步阐明。
系统的文献综述确定了12项候选研究；其中11项符合荟萃分析标准。我们采用随机效应模型分析了653名受试者（294例采用MI手术，359例采用MS手术）的结果。对每项研究进行异质性评估。主要终点是随访时的死亡率和肿瘤复发。次要终点包括相关的术中及术后结果；还考虑了肿瘤大小。
两组在晚期死亡率方面无显著差异（发病率比值[IRR]：MI组与MS组，0.98[95%置信区间[CI]：0.25 - 3.82]，p = 0.98）。两组均观察到很少的复发（IRR：1.13；CI：0.26 - 4.88；p = 0.87）和再次手术（IRR：1.92；95%CI：0.39 - 9.53；p = 0.42）；MI手术方式导致手术时间延长，但这并未影响临床结果。两组间肿瘤大小无显著差异。
MI和MS手术均具有良好的早期和晚期结果，生存率可接受，复发率低。本研究证实，采用MI手术方式可安全、彻底地治疗心脏肿瘤。
