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- Title
343-IONE-STAGE TRANS-STERNAL THYMECTOMY AND TRANSPERICARDIAL MEDIASTINAL NODAL DISSECTION FOR THYMIC NEOPLASM AND SUBCARINAL ADENOPATHY.
- Authors
Galetta, D.; Tessitore, A.; Casiraghi, M.; Gasparri, R.; Borri, A.; Petrella, F.; Pardolesi, A.; Spaggiari, L.
- Abstract
Objectives: Neuroendocrine thymic tumours (NTT) are rare and mediastinal involvement by these neoplasms is exceptional. Complete surgical resection of the tumour and the involved lymph node remains the treatment of choice. This video illustrates the imaging studies and the surgical technique adopted in a patient with NTT and subcarinal metastatic involvement.Methods: A 66-year-old woman, with fever and dry cough underwent a computed tomography (CT) scan and a positron emission tomography/CT scan which revealed a left anterior mediastinal mass associated with other thymic nodules and a subcarinal adenopathy. The preoperative histology of the thymic neoplasm obtained by a fine-needle biopsy revealed a malignant thymic neoplasm. Trans-carinal biopsy was negative for neoplasm. The multidisciplinary decision was to perform a one-stage extended thymectomy associated with a mediastinal nodal dissection.Results: Through a median sternotomy, an extended thymectomy was performed as a first step. Then, through the transpericardial approach (opening of the anterior and posterior pericardium and isolation of ascending aorta, superior vena cava and main right pulmonary artery), the mediastinal nodal dissection (#2R, #4R, #4L, #5 and #7) was performed. Definitive pathology showed a NTT without nodal involvement. The patient received adjuvant chemotherapy, and is alive without disease eight months after the operation.Conclusions: Complete surgical excision and adjuvant therapy appears to offer the best hope for prolonged survival for NTT. Surgical technique should be individualized according to tumour location. Thoracic surgeons should be familiar with this technique which provides a good technical and oncological result.
- Publication
Interactive Cardiovascular & Thoracic Surgery, 2013, Vol 17, Issue suppl_2, pS152
- ISSN
1569-9293
- Publication type
Article
- DOI
10.1093/icvts/ivt372.343