Importance of the multidisciplinary approach in the surgical treatment of giant mediastinal neoplasms: a case series.

Abstract

Background: Many reports described the importance of multidisciplinary meetings in providing oncologic patients with the best treatment strategies. This item improved overall survival, accuracy of staging and adherence to guidelines. For mediastinal neoplasms, collaboration between different surgical skills allows to deal with challenging/impossible surgical procedures. We report a series of four patients with a mediastinal-localized tumor with extensive infiltration of adjacent major structures. All cases were discussed at our multidisciplinary meeting where surgical indication was assessed. The presence of several surgical specialists, the role of anesthesiologists and sub-intensive clinicians was essential for proper operative and postoperative planning.

Case description: A 70-year-old patient with type-A thymoma underwent a via sternotomy thymectomy with an end-to-end caval anastomosis and an end-to-side anastomosis with the left brachiocephalic trunk by prosthesis. A 52-year-old patient with malignant peripheral nerve sheath tumor of left sternocleidomastoid muscle underwent surgical excision and chest wall reconstruction by Teflon prosthesis and pedicled flap from the rectus abdominis. A 41-year-old woman diagnosed with monophasic synovial sarcoma of the anterior mediastinum. After chemotherapy without benefit, she underwent debulking surgery with excision of this huge mass and right phrenic nerve reconstruction by neural graft from the contralateral phrenic nerve. A 23-year-old woman affected by myasthenia gravis (MG) with a type-B3 thymoma diagnosis. After chemotherapy without benefit, she underwent a thymectomy and left pneumectomy with reconstruction of the superior vena cava (SVC).

Conclusions: Multidisciplinary evaluation and surgical team are crucial in such complex cases to customize the most appropriate surgical planning and treatment.