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Surgical treatment of benign neurogenic tumours of the mediastinum: a single institution report

^a Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini Hospital, Rome, Italy
^b Department of Studi Geoeconomici, Linguistici, Statistici, Storici per l’Analisi Regionale, Sapienza University of Rome, Rome, Italy

Received 10 June 2008; received in revised form 3 August 2008; accepted 8 September 2008.

^_* Corresponding author. Tel.: +39 06 55180681; fax: +39 06 6638734. (Email: gcardillo{at}scamilloforlanini.rm.it).

Objective: Neurogenic tumours of the mediastinum are uncommon neoplasms arising from nerve tissues within the thorax. We sought to evaluate and compare the outcome following surgical resection of such tumours by VATS, open thoracotomy, and by either combined with hemilaminectomy. Methods: From February 1992 to March 2007, 93 patients underwent surgical resection of neurogenic tumours of the mediastinum in our institution. A videothoracoscopic approach was used in 57 cases (61.3%) (group V), of which 44 underwent VATS only and 13 required conversion to open approach. In the remaining 36 cases, 32 patients underwent thoracotomy (group T) and 4 had combined procedure with the neurosurgeons (group N). Results: No postoperative mortality was reported. Postoperative morbidity rate was 23.6% (22/93; 14 of group T, 4 of group N, and 4 of group V; p < 0.0001). Histology showed benign neurogenic tumours in all patients. Statistical analysis showed differences between the two groups (group V and T respectively) in mean operative time (111.3 ± 58.2 min vs 149.06 ± 77.05 min; p: 0.01), median postoperative stay (4 days vs 6 days p: 0.0009) and median postoperative pain on day 1, day 7 and 1 month after surgery (respectively p < 0.0001, p < 0.0001 and p: 0.001). At a mean follow-up of 73 months no patients showed recurrence of the tumour. Conclusions: VATS represents the gold standard for the treatment of benign neurogenic tumours of the mediastinum with better results in terms of morbidity, operative time, postoperative stay and postoperative pain compared to open approach. Dumbbell tumours require a combined thoracic and neurosurgical approach.

Key Words: Mediastinum • Peripheral nervous system neoplasms • Thoracic surgery • Video-assisted