Wei Zi-Yan, Chen Jin-Cheng, Lai Guang-Hu, Li Tong-Xin, Shen Ya-Lu, He Ping, Wu Tao, Wu Wei
Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Department of Thoracic Surgery, Banan Hospital of Chong Qing Medical University, Chongqing, China.
J Thorac Dis. 2025 Jun 30;17(6):3568-3576. doi: 10.21037/jtd-2024-2291. Epub 2025 Jun 6.
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).
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.
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).
Thoracic morphology (width and depth), rather than the depth of the anterior mediastinum, is a predictive factor for the difficulty of SVATS.
经剑突下入路的电视胸腔镜纵隔肿瘤切除术（SVATS）是治疗前纵隔肿瘤的主流手术方法。长期以来，胸廓和纵隔大小对手术的影响仅被描述为主观感受，尚无相关研究报道。在本研究中，我们回顾性调查了影响SVATS的术前预测因素，重点关注前纵隔深度和胸廓形态（宽度和深度）。
我们研究了133例纵隔肿瘤患者。所有患者均由经验丰富的资深医生通过剑突下入路进行电视胸腔镜手术。根据手术时间是否超过中位数，将患者分为困难组和普通组。我们收集了他们的临床资料、计算机断层扫描（CT）图像和术后结果。我们在CT图像上测量了胸骨到主动脉的距离、胸骨到脊柱的距离以及隆突水平胸腔的最大横径，分别代表前纵隔深度、胸腔深度和胸腔宽度。
所有患者均存活出院，纵隔肿瘤的平均最大直径为27.1 cm（四分位间距，21.70 - 37.35 cm）。两组患者在年龄、性别、体重指数（BMI）、术前心肺合并症、术后并发症、重症监护病房（ICU）停留时间或术后住院时间方面均无显著差异（所有P>0.05）。单因素回归分析显示，年龄、胸腔深度、胸腔宽度以及胸腔深度与宽度之比与手术难度相关（P = 0.02，P = 0.046，P = 0.03，P = 0.002）。多因素回归分析显示，SVATS困难的独立预测因素不包括前纵隔深度，而是胸腔深度（P = 0.006）和胸腔宽度（P = 0.003）。
胸廓形态（宽度和深度）而非前纵隔深度是SVATS手术难度的预测因素。
