Experience of Surgical Management of Mediastinal Masses in a Thoracic Surgical Unit of a Tertiary Care Hospital

Abstract

Background:  The aim of this study was to evaluate the role of surgical treatment and outcome for mediastinal massesMethods:  The retrospective study was done analyzing clinical record of 520 cases of mediastinal mass that underwent resectional surgery at Thoracic Surgery Department, Lady Reading Hospital, Peshawar from June 2002 to December 2014. Apart from routine investigations all patient had CT thorax done.Results:  Male: female ratio was 336:184. Age ranged from 9 days to 72 years with a median age of 33.6 years. The predominant clinical presentation was chest pain 231 (44%); dyspnea in 142 (27.3%) SVC syndrome in 90 (17%) cases, Dysphagia in 32 (6.1%) and Myasthenia gravis in 25 (4.8%) cases. Surgical approaches were anterolateral Thoracotomy in 34.6% (n=180) cases, posterolateral Thoracotomy in 35% (n=182), Median Sternotomy in 21% (n=110) and cervical incision and partial Sternotomy in 9.2% (n=48) cases. The histological diagnosis of the excised Lesions were Retrosternal goiters in 27% (n=141) cases, Thymoma in 11.9% (n=62), Dermoid cyst 11.9% (n=62), teratodermoid 10.5% (n 55), Entrogenic cyst 9% (n=47) Neurofibroma 9.2% (n=48), Neurogenic cyst 5.1% (n=27), Pleuropericardial cyst 3.2% (n=17), Thymic cyst 6.7% (n=35), Bronchogenic cyst 5% (n=26). Mortality was 3.6% and morbidity was 6.34% i.e. wound infection 17, hemorrhage 7, airleak 6 and hoarsness 3.Conclusion:  Surgery is the management of choice for patients with mediastinal lesions. It allows for establishing histologic diagnosis; alleviating symptoms and prevention of complications; with low operating risks. Mediastinal pathology is best dealt surgically in a properly equipped and staffed cardiothoracic unit.