Factors influencing the difficulty of video-assisted thoracoscopic anterior mediastinal tumor resection via the subxiphoid approach.

BACKGROUND

Video-assisted thoracoscopic mediastinal tumor resection via the subxiphoid approach (SVATS) is the mainstream surgical method for treating anterior mediastinal tumors. The impact of thoracic and mediastinal size on surgery has long been described only as a subjective feeling, and no related research has been reported. In this study, we retrospectively investigated the preoperative predictive factors affecting SVATS, focusing on the depth of the anterior mediastinum and thoracic morphology (width and depth).

METHODS

We studied 133 patients with mediastinal tumors. All had video thoracoscopic surgery through a subxiphoid approach by skilled senior doctors. Patients were divided into the difficult group and the common group according to whether the operation time exceeded the median value. We gathered their clinical data, computed tomography (CT) scans, and postoperative outcomes. We measured the distance from the sternum to the aorta, from the sternum to the spine, and the maximum transverse diameter of the thoracic cavity at the carina level on CT scans, representing the anterior mediastinal depth, thoracic cavity depth, and thoracic cavity width, respectively.

RESULTS

All the patients were discharged alive, and the average maximum diameter of the mediastinal tumor was 27.1 cm (interquartile range, 21.70-37.35 cm). There were no significant differences in age, sex, body mass index (BMI), preoperative cardiopulmonary comorbidities, postoperative complications, intensive care unit (ICU) stay, or postoperative hospital stay between the two groups (all P>0.05). Univariate regression analysis revealed that age, thoracic cavity depth, thoracic cavity width, and the ratio of thoracic cavity depth to width were associated with surgical difficulty (P=0.02, P=0.046, P=0.03, P=0.002). Multivariate regression analysis revealed that the independent predictive factors for difficult SVATS did not include the depth of the anterior mediastinum, but rather the depth of the thoracic cavity (P=0.006) and the width of the thoracic cavity (P=0.003).

CONCLUSIONS

Thoracic morphology (width and depth), rather than the depth of the anterior mediastinum, is a predictive factor for the difficulty of SVATS.