Combined minimally invasive resection of thoracic neurogenic dumbbell tumors: A European case series

Abstract

Background: Paraspinal tumors are rare neoplasms arising from neurogenic elements of the posterior mediastinum and surgical resection can be challenging. Here, we demonstrate feasibility and outcomes from the first European case series of combined laminectomy and video-assisted thoracoscopic surgery (VATS) resection of thoracic neurogenic dumbbell tumors.

Methods: A retrospective review of all combined thoracic dumbbell tumor resections performed at our institution between March 2015 to February 2019 was undertaken. Outcomes included operative time, blood loss, length of stay and recurrence rate. Statistical analysis was performed with SPSS statistics (v26). Values are given as mean ± standard deviation and median ± interquartile range.

Results: Seven patients were included in the case series and there were no major complications or mortality. Mean tumor size and operative time were 66 (± 35) mm and 171 (± 63) min, respectively. Median blood loss and length of stay were 40 (± 70) ml and four (± 3) days, respectively. One patient required conversion to thoracotomy to remove a tumor of 135 mm in maximal dimension. Histology in all seven cases confirmed schwannoma. There was no disease recurrence at a maximum follow-up of 54 months.

Conclusions: Our experience demonstrates favorable operative times, minimal blood loss and short length of stay when dealing with relatively large tumors compared to previous reports. Thoracotomy may be required for tumors exceeding 90 mm and chest drain removal on the operative day can facilitate early mobility and discharge. We advocate a combined, minimally invasive laminectomy and VATS resection as the gold-standard approach for thoracic neurogenic dumbbell tumors.

Keywords: minimally invasive surgery; neurogenic thoracic tumors; surgical oncology; video-assisted thoracoscopic surgery.

FIGURE 1

Preoperative T1 weighted magnetic resonance imaging (MRI) of Patient 3 demonstrating a paraspinal dumbbell tumor in the right hemithorax at the T4/5 level (red arrow) extending into the intervertebral foramen (yellow dotted line and circle). (a) axial section; (b) sagittal section

FIGURE 2

Standard 3‐port video‐assisted thoracoscopic surgery (VATS) port placement for the thoracic component of the dumbbell tumor resection (top, cranial; bottom, caudal; left, anterior; right, posterior)

FIGURE 3

Thoracoscopic view of the paraspinal tumor. The parietal pleura surrounding the tumor is mobilized