Experience with thoracoscopic resection for mediastinal mature teratoma: a retrospective analysis of 15 patients

Abstract

Objectives: Although video-assisted thoracoscopic surgery (VATS) is widely used for the resection of a mediastinal mass, it is converted to an open resection in some patients with a mature teratoma because of dense adhesions. We reviewed cases with a mature teratoma removed by VATS and investigated the indications for that procedure for this tumour.

Methods: We retrospectively investigated 15 patients with a benign mediastinal mature teratoma who underwent a thoracoscopic procedure.

Results: The mean tumour diameter was 5.3 cm (range 3.2-8.5). The mean operative time was 188 min (78-430), and intraoperative blood loss was 138 ml (10-450). Thoracoscopic resection was completed in all except 3 patients with larger tumours, which presented the most difficult problems with dissection. Each of those 3 had severe preoperative chest pain and a tumour larger than 5.5 cm. No mortality or postoperative complications were recorded, except for postoperative chylothorax. Tumour recurrence did not develop in any patient during the mean follow-up period of 4.6 years.

Conclusions: For selected patients with a mediastinal teratoma, VATS may be considered standard care, as most are benign. In contrast, an open approach may be more appropriate for patients with a large tumour or preoperative symptoms.

Video 1:

Thoracoscopic view showing accurate display of the phrenic nerve for its protection. The right mediastinal pleura was incised just anterior to the phrenic nerve (arrow).

Figure 1:

(A) Chest computed tomography image showing a well-circumscribed cystic tumour in the anterior mediastinum. (B) Thoracoscopic view showing adhesion between tumour and lung (arrow). (C) When dissecting the tumour from the phrenic nerve, the contents spilled due to breakage of the tumour capsule (arrow). (D) Aspiration of cystic components can provide a wider thoracoscopic view, leading to easier grasping and retraction from the tumour wall.

Video 2:

Thoracoscopic view showing thickened mediastinal pleura, and adhesions between the tumour and lung. The thickened pleura was incised just anterior to the phrenic nerve (arrow). The tumour was densely adhered to the pericardium.

Figure 2:

(A) Preoperative chest roentgenogram showed abnormal shadow on the left side of the mediastinum (arrow). (B) Preoperative chest roentgenogram taken after severe chest pain showing change in shape of an abnormal mass (arrow). (C) Thoracoscopic view showing thickened pleura and involvement of the phrenic nerve by the tumour (arrow). (D) Thoracoscopic view showing dense adhesions between tumour wall and pericardium (arrow).