Surgery in large anterior mediastinal mass: case series of Hospital Kuala Lumpur

Background: Mediastinal masses comprise of a wide variety of tumors and accounts for about 3% of tumors within the chest. Very few studies have been produced so far on large anterior mediastinal masses, as this pathology is infrequently encountered in clinical practice and tend to be asymptomatic until compression symptoms occur, which leads to mediastinal mass syndrome (MMS). The aim of this writing is to assess the surgical feasibility, approach, safety of resection and outcome in large anterior mediastinal masses. Methods: A retrospective review was conducted on patients referred for mediastinal mass to the Thoracic Surgery Unit, Hospital Kuala Lumpur from October 2017 until March 2020 (30 months). Patients with evidence of primary anterior mediastinal mass measuring >6 cm on contrast-enhanced computed tomography (CECT) of thorax and had undergone treatment in our centre were included. Data were analysed by proportions, means and standard deviations. Categorical data were expressed as percentage, whereas interquartile range was used to describe continuous variables. Results: Out of 63 patients with anterior mediastinal mass, 16 (25.4%) patients had anterior mediastinal mass larger than 6 cm and was included in the analysis. The average tumor size was 11.9 cm. Five patients (31.3%) had MMS. Twelve out of 16 patients were operated with 75% rate of clear tumor margin. There was no postoperative mortality recorded within 30 days of surgery. Conclusions: Positive outcome of definitive surgery in this series suggests clinical feasibility with acceptable short-term safety. Multidisciplinary approach with adequate preoperative assessment, intraoperative preparation and short- and long-term postoperative care were key features to successful treatment of this disease.