Optimal Surgical Approach for an Anterior Mediastinal Mature Teratoma: A Review of 13 Cases

Toshiya Fujiwara ¹, Ryuji Nakamura ², Atsushi Shimoda ², Masanori Okada ², Motoki Matsuura ²

¹ Hirosihima City Hiroshima Citizens Hospital, HIiroshima, Japan; ² Hirosihima City Hiroshima Citizens Hospital, Hiroshima, Japan;

Date, time and location: 2018.05.25 15:30, Congress Hall, 2F–C

Abstract

Objectives: Anterior mediastinal mature teratomas adhere to and penetrate adjacent organs. We investigated an appropriate surgical approach for resecting such tumors.

Methods: We retrospectively reviewed results of 13 cases of mediastinal mature teratoma that were surgically resected between 2006 and 2016.

Results: Mean age of the patients was 35 years (range, 17–64 years). Among 13 patients, 6 (46%) were males and 7 (54%) were females. Mean tumor diameter was 7.4 cm (range, 2.8–13.5 cm). Tumors were incidentally detected in 9 (69%) patients during annual medical checkups, but 4 (31%) patients were symptomatic, with chest pain or cough. Seven (54%) underwent thoracotomy by median sternotomy (MS group), and six (46%) patients underwent thoracoscopic resection (TS group). Nine (69%) patients underwent the simple extirpation of tumor, whereas; others in the TS group required a combination resection of the adjacent organs. Mean operative time was 202.3 min (52–467 min.), and intraoperative blood loss was 246.5 ml (0–1400 ml). No mortality were recorded. We compared results between the MS and TS groups. No significant difference was observed in terms of age and sex. The MS group showed a higher number of symptomatic cases (57% vs 0%, p=0.026) and greater tumor diameter (8.9 cm vs 5.7 cm, p=0.04) than the TS group. No significant difference was observed in radiographic findings. However, intratumoral gas is an important finding suggesting tumor penetration into the lungs, which affects the choice of surgical approach. The number of patients in the MS group who required the resection of adjacent organs was significantly greater than that in the TS group (43% vs 0%, p=0.026), operative time was longer (274 min. vs 118 min, p=0.016) and blood loss was greater (453 g vs 6 g, p=0.038) in the MS group than in the TS group.

Conclusions: Thoracoscopic approach may be appropriate in selected patients with a mediastinal mature teratoma, whereas thoracotomy may be required in patients with large tumors or preoperative symptoms due to dense adhesions or penetration into adjacent organs.