Clamshell thoracotomy for mediastinal mass resection: technical refinements and short-term outcomes in the largest single-center cohort.

BACKGROUND

The clamshell thoracotomy remains controversial for mediastinal mass resection because of its extensive exposure but significant injuries. This study evaluated its modern indications, technical refinements, and short-term outcomes at a high-volume center.

METHODS

A single-center, single-arm prospective investigation was conducted on 78 patients who underwent clamshell thoracotomy for mediastinal masses. Two CT-based radiological parameters were developed to quantify anatomical complexity. Short-term outcomes were presented and analyzed.

RESULTS

The cohort (median age 51 years; 71.8% male) included 68 primary tumors and 10 recurrent/metastatic tumors. The median operative time was 275 minutes, with a blood loss of 500 mL. Pulmonary resections (79.5%) and vascular reconstructions (65.4%) were frequently required. The postoperative 90-day mortality rate was 5.1%. The radiological classification was proposed as four types: A (bulky), B (hilar), C (deep-tricky), and D (mixed). Modified incisions might reduce tissue trauma without compromising exposure.

CONCLUSIONS

Clamshell thoracotomy was essential for addressing giant or deep mediastinal tumors, particularly when vascular control or multiplanar dissection was necessary. The CT-based radiological parameters and the classification might improve preoperative planning. All these reflected a single center's experience and criteria.