Šafránek J., Špidlen V., Vodička J.: Mediastinal Cysts, Surgical Management

Česká verzia

Authors: J. Šafránek; V. Špidlen; J. Vodička
Authors place of work: Chirurgická klinika FN Plzeň, přednosta: prof. MUDr. V. Třeška, DrSc.
Published in the journal: Rozhl. Chir., 2011, roč. 90, č. 5, s. 277-280.
Category: Monothematic special - Original

Summary

Introduction:
Mediastinal cysts are common lesions, affecting children, as well as adults. They account for 20–30 % pathological mediastinal masses. The treatment is surgical, including extirpation, respectively enucleation of the cyst.

Aim of the study:
Assessment of the author’s patient group and overview of current literature data.

Material and Methods:
Retrospective analysis of a group of 11 patients (9 female and2 male subjects, the mean age was 47.6 years) indicated for scheduled procedures for mediastinal cysts from 2006 to 2010.

Results:
Histological examination confirmed pericardial cysts in 7 subjects (63.6%), brochogenic cysts in 3 (27.3%) subjects and a thymic cyst in one subject (9.1%). The commonest location was anterior mediastinum – 7 subjects (63.6%), whereas upper mediastinum was the cyst site in 3 (27.3%) subjects and posterior mediastinum in 1 (9.1%) subject. Thoracotomy was indicated in 3 subjects, one subject was indicated for lung resection for carcinoma using thoracotomy and the pericardial cyst was a secondary known diagnosis, one patient was operated using sternotomy. 6 patients were indicated for videothoracoscopic (VTS) procedures and a decision to convert to thoracotomy was taken in 2 of these subjects. The patients were discharged from hospital 4–12 days after thoracotomy (the mean of 6.67 days), 3–4 days after VTS (the mean of 3.25 days), while the patient undergoing sternotomy was discharged on the postoperative Day 8. The mean size of the cysts removed using thoracotomy was 78 x 55 mm and the mean size of the cysts removed using VTS was 50 x 29 mm.

Conclusion:
The surgical technique for expected mediastinal cysts should be selected based on the cysts location, rather than on their size. The main objective is to indicate each mediastinal cyst for VTS (shorter duration of hospitalization) and eventual conversion to thoracotomy does not cause any delays or complications. Also asymptomatic cysts should be indicated for surgery.

Key words:
mediastinal cysts – videothoracoscopy – thoracotomy

Zdroje

1. Martin, J., Deslauriers, J., Duranceu, A. CH. chapter 195, Foregut Cyst of the Mediastinum. In: Shields, T. W.: General Thoracic Surgery. 6th edition. Lippincott Williams&Wilkins 2005, volume 2, pp. 2830–2841.

2. Kaiser, L. R., Singhal, S. in Essential of Thoracic Surgery, Elsevier Mosby, 2004 Philadelphia, Pennsylvania, Mediastinal Masses, p. 345–348.

3. Sirivella, S., Gielchinsky, I., Parsonnet, V. Mediastinal thymic cysts: A report of three cases. Original Research Artikle. The Journal of Thoracic and Cardiovascular Surgery, Volume 110, Issue 6, December 1995, Pages 1771–1772.

4. Ozpolat, B., Ozeren, M., Soyal, T., Yucel, E. Unusually located intrathoracic extrapulmonary mediastinal hydatid cyst manifesting as Pancoast syndrome. The Journal of Thoracic and Cardiovascular Surgery, Volume 129, Issue 3, March 2005, Pages 688–689.

5. Strollo, D. C., Rosado de Christenson, M. L., Jett, J. R. Primary mediastinal tumors. Part II. Tumors of the middle and posterior mediastinum. Chest, 1997; 112: 1344–1357.

6. Satur, C. M. R., Hsin, M. K. Y., Dussek, J. E. Giant pericardial cysts Original Research Artikle. The Annals of Thoracic Surgery, Volume 61, Issue 1, January 1996, Pages 208–210.

7. Kanemitsu, Y., Nakayama, H., Asamura, H., Kondo, H., Tsuchiya, R., Naruke, T. Clinical features and management of bronchogenic cysts: report of 17 cases. Surg. Today, 1999; 29: 1201–1205.

8. Martinod, E., Pons, F., Azorin, J., Mouroux, J., Dahan, M., Faillon, J.-M., Dujon, A., Lajos, P. S., Riquet, M., Jancovici, R. Thoracoscopic excision of mediastinal bronchogenic cysts: results in 20 cases Original Research Article. The Annals of Thoracic Surgery, Volume 69, Issue 5, May 2000, Pages 1525–1528.

9. Merchán, R. J., Loscertales, M. C., Valera, G. G., Jarne, J. A., Loscertales, J. Resection of 8 Mediastinal Bronchogenic Cysts by Video-Assisted Thoracoscopy. Archivos de Bronconeumología (English Edition), Volume 44, Issue 4, 2008, Pages 220–223.

10. Kirmani, B., Kirmani, B., Sogliani, F. Should asymptomatic bronchogenic cysts in adults be treated conservatively or with surgery? (Best evidence topic - Thoracic oncologic). Interact CardioVasc. Thorac. Surg., 2010; 11: 649–659.

11. Zambudio, A. R., Lanzas, J. T., Calvo, M. J. R., Fernández, P. J. G., Paricio, P. P. Non-neoplastic mediastinal cysts Original Research Article. European Journal of Cardio-Thoracic Surgery, Volume 22, Issue 5, November 2002, Pages 712–716.

12. Hazelrigg, S. R., Landreneau, R. L., Mack, M. J., Acuff, T. E. Thoracoscopic resection of mediastinal cysts Original Research Article. The Annals of Thoracic Surgery, Volume 56, Issue 3, September 1993, Pages 659–660.

13. Naunheim, K. S., Andrus, CH. Thoracoscopic drainage and resection of giant mediastinal cyst Original Research Article. The Annals of Thoracic Surgery, Volume 55, Issue 1, January 1993, Pages 156–158.

14. Urschel, J. D., Horan, T. A. Mediastinoscopic treatment of mediastinal cysts Original Research Article. The Annals of Thoracic Surgery, Volume 58, Issue 6, December 1994, Pages 1698–1700.

15. Pop, D., Venissac, N., Leo, F., Mouroux, J. Video-assisted mediastinoscopy: a useful technique for paratracheal mesothelial cysts. J. Thorac. Cardiovasc. Surg., 2005; 129: 690–691.

16. Kuzdzal, J., Zielinski, M., Papla, B., Szlubowski, A., Hauer, L., Nabialek, T., Sosnicki, W., Pankowski, J. Transcervical extended mediastinal lymphadenectomy – the new operative technique and early results in lung cancer staging. Eur. J. Cardiothorac. Surg., 2005; 27: 384–390.

17. Nakajima, T., Yasufuku, K., Shibuya, K., Fujisawa, T. Endobronchial ultrasound-guided transbronchial needle aspiration for the treatment of central airway stenosis caused by a mediastinal cyst. European Journal of Cardio-Thoracic Surgery, Volume 32, Issue 3, September 2007, Pages 538–540.