JTCVS open · 2025
The surgical management of mediastinal paragangliomas: A modern series reflecting true collaboration between cardiac and thoracic surgeons.
СтатьяНазвание и аннотация: Перевод в очереди
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Kazerouni Kayvan, Abt Brittany G, Wightman Sean C, Harano Takashi, Udelsman Brooks V, Rosenberg Graeme M, Praeger Jonathan, Baker Craig J, Starnes Vaughn A, McFadden Paul Michael, Kim Anthony W, Atay Scott M
Аннотация
OBJECTIVE: The study objective was to evaluate the perioperative management and outcomes of operation for patients undergoing mediastinal paraganglioma resection at Keck Medical Center of University of Southern California.
METHODS: Six patients underwent surgical management for mediastinal paraganglioma from 2018 to 2024. Perioperative data were collected through retrospective review of the electronic medical record.
RESULTS: The median age was 61 years (range, 27-69). Five patients (83%) demonstrated elevated levels of urinary or plasma metanephrines. Germline genetic testing demonstrated a pathogenic mutation consistent with paraganglioma-pheochromocytoma syndrome in 3 patients (50%). A multidisciplinary approach was used in all cases, with cardiac and thoracic surgical staff attending to each patient. Operative approach was via median sternotomy in 4 patients (67%), clamshell thoracotomy in 1 patient (17%), and right posterolateral thoracotomy in 1 patient (17%). Cardiopulmonary bypass was used in 3 patients (50%); 2 patients required great vessel transection for exposure, and 1 patient required en bloc resection of the right main coronary due to tumor encasement. R0 resection was achieved in all patients. Median intensive care unit and hospital length of stay were 2.5 days (range, 1-4) and 5 days (range, 4-9), respectively. The predominant method of postoperative surveillance was biannual chest computed tomography, with no patients demonstrating radiographic evidence of recurrence during a median follow-up of 22.5 months (range, 6.5-85).
CONCLUSIONS: Surgical resection of mediastinal paraganglioma is safe and feasible with a multidisciplinary approach. The use of cardiopulmonary bypass, although occasionally necessary, did not result in adverse outcomes. All patients achieved an R0 resection with minimal postoperative complications, and no evidence of recurrence has been observed during the follow-up period.
METHODS: Six patients underwent surgical management for mediastinal paraganglioma from 2018 to 2024. Perioperative data were collected through retrospective review of the electronic medical record.
RESULTS: The median age was 61 years (range, 27-69). Five patients (83%) demonstrated elevated levels of urinary or plasma metanephrines. Germline genetic testing demonstrated a pathogenic mutation consistent with paraganglioma-pheochromocytoma syndrome in 3 patients (50%). A multidisciplinary approach was used in all cases, with cardiac and thoracic surgical staff attending to each patient. Operative approach was via median sternotomy in 4 patients (67%), clamshell thoracotomy in 1 patient (17%), and right posterolateral thoracotomy in 1 patient (17%). Cardiopulmonary bypass was used in 3 patients (50%); 2 patients required great vessel transection for exposure, and 1 patient required en bloc resection of the right main coronary due to tumor encasement. R0 resection was achieved in all patients. Median intensive care unit and hospital length of stay were 2.5 days (range, 1-4) and 5 days (range, 4-9), respectively. The predominant method of postoperative surveillance was biannual chest computed tomography, with no patients demonstrating radiographic evidence of recurrence during a median follow-up of 22.5 months (range, 6.5-85).
CONCLUSIONS: Surgical resection of mediastinal paraganglioma is safe and feasible with a multidisciplinary approach. The use of cardiopulmonary bypass, although occasionally necessary, did not result in adverse outcomes. All patients achieved an R0 resection with minimal postoperative complications, and no evidence of recurrence has been observed during the follow-up period.