Browse > Article

Is Video-assisted Thoracoscopic Resection for Treating Apical Neurogenic Tumors Always Safe?  

Cho, Deog Gon (Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, The Catholic University of Korea)
Jo, Min Seop (Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, The Catholic University of Korea)
Kang, Chul Ung (Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, The Catholic University of Korea)
Cho, Kyu Do (Department of Thoracic and Cardiovascular Surgery, St. Vincent’s Hospital, The Catholic University of Korea)
Choi, Si Young (Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea)
Park, Jae Kil (Department of Thoracic and Cardiovascular Surgery, St. Mary’s Hospital, The Catholic University of Korea)
Jo, Keon Hyeon (Department of Thoracic and Cardiovascular Surgery, Kangnam St. Mary’s Hospital, The Catholic University of Korea)
Publication Information
Journal of Chest Surgery / v.42, no.1, 2009 , pp. 72-78 More about this Journal
Abstract
Background: Mediastinal neurogenic tumors are generally benign lesions and they are ideal candidates for performing resection via video-assisted thoracoscopic surgery (VATS). However, benign neurogenic tumors at the thoracic apex present technical problems for the surgeon because of the limited exposure of the neurovascular structures, and the optimal way to surgically access these tumors is still a matter of debate. This study aims to clarify the feasibility and safety of the VATS approach for performing surgical resection of benign apical neurogenic tumors (ANT). Material and Method: From January 1996 to September 2008, 31 patients with benign ANT (15 males/16 females, mean age: 45 years, range: 8~73), were operated on by various surgical methods: 14 VATS, 10 lateral thoracotomies, 6 cervical or cervicothoracic incisions and 1 median sternotomy. 3 patients had associated von Recklinhausen's disease. The perioperative variables and complications were retrospectively reviewed according to the surgical approaches, and the surgical results of VATS were compared with those of the other invasive surgeries. Result: In the VATS group, the histologic diagnosis was schwannoma in 9 cases, neurofibroma in 4 cases and ganglioneuroma in 1 case, and the median tumor size was 4.3 cm (range: 1.2~7.0 cm). The operation time, amount of chest tube drainage and the postoperative stay in the VATS group were significantly less than that in the other invasive surgical group (p<0.05). No conversion thoracotomy was required. There were 2 cases of Hornor's syndrome and 2 brachial plexus neuropathies in the VATS group; there was 1 case of Honor's syndrome, 1 brachial plexus neuropathy, 1 vocal cord palsy and 2 non-neurologic complications in the invasive surgical group, and all the complications developed postoperatively. The operative method was an independent predictor for postoperative neuropathies in the VATS group (that is, non-enucleation of the tumor) (p=0.029). Conclusion: The VATS approach for treating benign ANT is a less invasive, safe and feasible method. Enucleation of the tumor during the VATS procedure may be an important technique to decrease the postoperative neurological complications.
Keywords
Thoracoscopy; Mediastinum; Neurogenic tumors;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Venissac N, Leo F, Hofman P, Paquis P, Mouroux J. Mediastinal neurogenic tumors and video-assisted thoracoscopy; always the right choice? Surg Laparosc Endosc Percutan Tech 2004;14:20-2
2 Riquet M, Mouroux J, Pons F, et al. Videothoracoscopic excision of thoracic neurogenic tumors. Ann Thorac Surg 1995;60:943-6   DOI   ScienceOn
3 Endo S, Murayama F, Otani S, et al. Alternative surgical approaches for apical neurinomas: a thoracoscopic approach. Ann Thorac Surg 2005;80:295-8   DOI   ScienceOn
4 Hajdu SI. Peripheral nerve sheath tumors. Histogenesis, classification and prognosis. Cancer 1993;72:3549-52   DOI   ScienceOn
5 Macchiarini P, Dartevelle P, Chapelier A, et al. Technique for resecting primary and metastatic nonbronchogenic tumors of the thoracic outlet. Ann Thorac Surg 1993;55:611-8   DOI   ScienceOn
6 Bousamura M, Haasler GB, Patterson GA, Roper CL. A comparative study of thoracoscopic vs open removal of benign neurogenic mediastinal tumors. Chest 1996;109:1461-5   DOI   ScienceOn
7 Grunenwald D, Spaggiari L. Transmanubrial osteomuscular sparing approach for apical chest tumors. Ann Thorac Surg 1997;63:563-6   DOI   ScienceOn
8 Kim YS, Kim KT, Son HS, et al. Video-assisted thoracoscopic surgery for mediastinal lesions. Korean J Thorac Cardiovasc Surg 1998;31:40-5
9 Konno S, Yabuki S, Kinoshita T, et al. Combined laminectomy and thoracoscopic resection of dumbbell-type thoracic cord tumor. Spine 2001;26:130-4   DOI   ScienceOn
10 Landreneau RJ, Dowling RD Ferson PF. Thoracoscopic resection of a posterior mediastinal neurogenic tumor. Chest 1992;102:1288-90   DOI   ScienceOn
11 Roviano G, Rebuffat C, Varroli F, et al. Video-thoracoscopic excision of mediastinal masses: Indication and technique. Ann Thorac Surg 1994;58:1679-84   DOI   ScienceOn
12 Yamaguchi M, Yoshino I, Fukuyama S, et al. Surgical treatment of neurogenic tumors of the chest. Ann Thorac Cardiovasc Surg 2004;1:148-51
13 Zierold D, Halow KD. Thoracoscopic resection as the pre ferred approach to posterior mediastinal tumors. Surg Laparosc Edosc 2000;10:222-5   DOI
14 Ladas G, Rhys-Evans PH, Goldstraw P. Anterior cervical- transsternal approach for resection of benign tumors at the thoracic inlet. Ann Thorac Surg 1999;67:785-9   DOI   ScienceOn
15 Pons F, Lang-Lazdunski L, Bonnet PM, Meyrat L, Jancovici R. Videothoracoscopic resection of neurogenic tumors of the superior sulcus using the harmonic scalpel. Ann Thorac Surg 2003;75:602-4   DOI   ScienceOn
16 .Fujino K, Shinohara K, Aoki M, et al. Intracapsular enucleation of vagus nerve-originated tumors for preservation of neural function. Otolaryng Head Neck 2000;123:334-6   DOI