Tacchi Giovanni, Frasca Luca, Longo Filippo, Crucitti Pierfilippo
Thoracic Surgery Unit, Campus Bio-Medico University, Rome, Italy.
PhD in Microbiology, Immunology, Infectious Diseases and Transplants (MIMIT), University of Rome Tor Vergata, Rome, Italy.
AME Case Rep. 2024 Nov 6;9:33. doi: 10.21037/acr-24-23. eCollection 2025.
Many reports described the importance of multidisciplinary meetings in providing oncologic patients with the best treatment strategies. This item improved overall survival, accuracy of staging and adherence to guidelines. For mediastinal neoplasms, collaboration between different surgical skills allows to deal with challenging/impossible surgical procedures. We report a series of four patients with a mediastinal-localized tumor with extensive infiltration of adjacent major structures. All cases were discussed at our multidisciplinary meeting where surgical indication was assessed. The presence of several surgical specialists, the role of anesthesiologists and sub-intensive clinicians was essential for proper operative and postoperative planning.
A 70-year-old patient with type-A thymoma underwent a via sternotomy thymectomy with an end-to-end caval anastomosis and an end-to-side anastomosis with the left brachiocephalic trunk by prosthesis. A 52-year-old patient with malignant peripheral nerve sheath tumor of left sternocleidomastoid muscle underwent surgical excision and chest wall reconstruction by Teflon prosthesis and pedicled flap from the rectus abdominis. A 41-year-old woman diagnosed with monophasic synovial sarcoma of the anterior mediastinum. After chemotherapy without benefit, she underwent debulking surgery with excision of this huge mass and right phrenic nerve reconstruction by neural graft from the contralateral phrenic nerve. A 23-year-old woman affected by myasthenia gravis (MG) with a type-B3 thymoma diagnosis. After chemotherapy without benefit, she underwent a thymectomy and left pneumectomy with reconstruction of the superior vena cava (SVC).
Multidisciplinary evaluation and surgical team are crucial in such complex cases to customize the most appropriate surgical planning and treatment.
许多报告描述了多学科会议在为肿瘤患者提供最佳治疗策略方面的重要性。这一举措提高了总生存率、分期准确性并增强了对指南的遵循。对于纵隔肿瘤，不同手术技能之间的协作有助于处理具有挑战性/无法进行的手术。我们报告了一系列4例纵隔局限性肿瘤患者，其肿瘤广泛浸润相邻主要结构。所有病例均在我们的多学科会议上进行了讨论，评估了手术指征。多名外科专家的参与、麻醉医生和亚重症临床医生的作用对于恰当的手术和术后规划至关重要。
一名70岁的A型胸腺瘤患者接受了经胸骨正中切口胸腺切除术，术中进行了端端腔静脉吻合以及通过假体与左头臂干进行端侧吻合。一名52岁的左侧胸锁乳突肌恶性外周神经鞘瘤患者接受了手术切除，并使用特氟龙假体和腹直肌带蒂皮瓣进行胸壁重建。一名41岁女性被诊断为前纵隔单相滑膜肉瘤。化疗无效后，她接受了减瘤手术，切除了这个巨大肿块，并通过取自对侧膈神经的神经移植物进行了右膈神经重建。一名23岁患有重症肌无力（MG）且诊断为B3型胸腺瘤的女性。化疗无效后，她接受了胸腺切除术和左肺切除术，并进行了上腔静脉（SVC）重建。
在这类复杂病例中，多学科评估和手术团队对于制定最合适的手术规划和治疗方案至关重要。
