Primary cysts and tumors of the mediastinum
Cistos e tumores primários do mediastino
Pedro Bastos1,
, Adriana Magalhães2, Gabriela Fernandes2, Maria Rosa Cruz2, Sandra Saleiro3, Luís Gonçalves4, Miguel Piñon4, Paulo Pinho5, Pedro Bastos6, J. Agostinho Marques7
Corresponding author
pbastos@hsjoao.min-saude.pt
Correspondence to/Correspondência: Serviço de Cirurgia Torácica , Hospital de S. João. Alameda Professor Hernâni Monteiro 4202-451 Porto. Telefone: 225502417.
Correspondence to/Correspondência: Serviço de Cirurgia Torácica , Hospital de S. João. Alameda Professor Hernâni Monteiro 4202-451 Porto. Telefone: 225502417.
1 Director da Unidade Autónoma de Gestão de Cirurgia, Chefe de Serviço de Cirurgia Torácica e Professor Associado Convidado da Faculdade de Medicina / Director, Autonomous Surgery Management Unit, Head, Chest Surgery Department and Guest Associate Professor, Faculty of Medicine
2 Assistente Hospitalar de Pneumologia / Pulmonology Consultant
3 Interna Complementar de Pneumologia / Pulmonology Resident
4 Assistente Hospitalar de Cirurgia Torácica / Thoracic Surgery Consultant
5 Serviço de Cirurgia Torácica do Hospital de S. João./ Thoracic Surgery Unit, Hospital de S. João.
6 Serviço de Cirurgia Torácica da Faculdade de Medicina da Universidade do Porto. / Thoracic Surgery Unit, Universidade de Porto Faculty of Medicine.
7 Serviço de Pneumologia do Hospital de S. João e da Faculdade de Medicina da Universidade do Porto. // Pulmonology Unit, Hospital de S. João and Universidade de Porto Faculty of Medicine.
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João./ Thoracic Surgery Unit, Hospital de S. João." "etiqueta" => "<span class="elsevierStyleSup">5</span>" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Serviço de Cirurgia Torácica da Faculdade de Medicina da Universidade do Porto. / Thoracic Surgery Unit, Universidade de Porto Faculty of Medicine." "etiqueta" => "<span class="elsevierStyleSup">6</span>" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Serviço de Pneumologia do Hospital de S. João e da Faculdade de Medicina da Universidade do Porto. // Pulmonology Unit, Hospital de S. João and Universidade de Porto Faculty of Medicine." "etiqueta" => "<span class="elsevierStyleSup">7</span>" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondence to/Correspondência: Serviço de Cirurgia Torácica , Hospital de S. João. Alameda Professor Hernâni Monteiro 4202-451 Porto. Telefone: 225502417." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Cistos e tumores primários do mediastino" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-12-13" "fechaAceptado" => "2007-04-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec159217" "palabras" => array:3 [ 0 => "Mediastinal cysts" 1 => "mediastinal tumours" 2 => "general thoracic surgery" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec159218" "palabras" => array:3 [ 0 => "Cistos do mediastino" 1 => "tumores do mediastino" 2 => "cirurgia torácica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To assess results in patients with primary cysts and tumours of the mediastinum who underwent surgery.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A retrospective single-centre study was undertaken into patients with primary cysts and tumours of the mediastinum who underwent surgery between January 1992 and December 2004. We analysed demographic data, clinical presentation, type of surgery carried out and procedure, lesion location and histological diagnosis. Predictive malignancy factors were also evaluated. Postoperative morbidity and mortality were noted, as was medium-term results.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">171 patients underwent surgery over a 13-year period; 73 female (43%) and 98 male (57%). Mean age was 40.3±19.7 years (20 days-78 years). A primary cystic lesion was present in 15 patients (9%). The primary tumours included thymic neoplasms (31%), lymphoma (22%), neurogenic tumours (16%), germ cell tumours (9%) and a miscellaneous group (13%). Malignant neoplasms were present in 78 patients (46%). The antero-superior mediastinum was the most commonly involved site to have a primary cyst or tumour (58%), followed by the posterior mediastinum (24%) and the middle mediastinum (18%). Symptoms were present in 68% of the patients and included chest pain (20%), fever and chills (13%), myasthenia gravis (11%), cough (10%), dyspnoea (10%), and superior vena caval syndrome (7%). Univariate analysis identified symptoms as a predictive factors of malignancy (p<0.001). Types of surgery carried out included postero-lateral thoracotomy (64 patients), median sternotomy (51 patients), anterior mediastinostomy (27 patients), antero- lateral thoracotomy (18 patients), video-assisted thoracic surgery (9 patients) and mediastinoscopy (2 patients). Total excision was performed in 116 patients, enlarged resection in 8 patients, subtotal resection in 7 patients and biopsy in 40 patients. There was one postoperative death (0.6%). Follow-up was available in 165 patients (96.5%) and ranged from 34 days to 13.4 years (mean 5.7±4.0 years). Complementary treatment with chemo and/or radiotherapy was provided in 75 patients. Six patients had to be reoperated on for local recurrence (3) or metastasis (3) of the primary lesion. Fifteen patients died of their disease during the follow-up period. Actuarial survival at five years was 97.6% for benign lesions and 76.4% for malignant tumours.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Results support surgical resection for benign lesions and an aggressive multimodal approach for malignant tumours.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<span class="elsevierStyleSectionTitle">Objectivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Avaliação dos resultados em doentes com cistos e tumores primários do mediastino submetidos a tratamento cirúrgico.</p> <span class="elsevierStyleSectionTitle">Material e métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Efectuado um estudo retrospectivo mono-institucional em doentes com cistos e tumores primários do mediastino submetidos a tratamento cirúrgico entre Janeiro de 1992 e Dezembro de 2004. Analisaram-se os dados demográficos, a apresentação clínica, a via de abordagem, a intervenção cirúrgica efectuada, a localização da lesão e o diagnóstico histológico. Avaliaram-se, ainda, os factores preditivos de malignidade, a morbilidade e mortalidade pós--operatórias e os resultados a médio prazo.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ao longo de um período de 13 anos foram operados 171 doentes, 73 (43%) do sexo feminino e 98 (57%) do sexo masculino. A idade média foi de 40,3±19,7 anos (20 dias-78 anos). Em 15(9%) dos doentes existia uma lesão cística primária. Os tumores primários incluíam neoplasias tímicas (31%), linfomas (22%), tumores neurogénicos (16%), tumores de células germinativas (9%) e um grupo miscelâneo (13%). Em 78 doentes (46%) as lesões eram malignas. O mediastino ântero-superior foi o compartimento mais frequentemente envolvido por um cisto ou tumor primário (58%), seguido do mediastino posterior (24%) e do mediastino médio (18%). Em 68% dos doentes existiam sintomas na altura do diagnóstico: dor torácica (20%), febre e arrepios (13%), miastenia grave (11%), tosse (10%), dispneia (10%) e síndroma da veia cava superior (7%). A análise unifactorial identificou a existência de sintomas como factor preditivo de malignidade (p<0,001). A abordagem cirúrgica foi feita por toracotomia póstero-lateral (64 doentes), esternotomia mediana (51), mediastinostomia anterior (27), toracotomia ântero-lateral (18), videotoracoscopia (9 doentes) e mediastinoscopia (2). Em 116 doentes foi efectuada ressecção total da lesão, em 8 ressecção alargada, em 7 ressecção subtotal e em 40 biópsia. Um doente (0,6%) morreu no período pós-operatório. O <span class="elsevierStyleItalic">follow-up</span> englobou 165 doentes (96,5%) e variou entre 34 dias e 13,4 anos (médio 5,7±4,0 anos). Em 75 doentes foi efectuado tratamento complementar com quimio e/ou radioterapia. Seis doentes foram reoperados por recorrência local (3) ou metástases (3) da lesão primária. Quinze faleceram em consequência da sua doença durante o período de <span class="elsevierStyleItalic">follow-up</span>. A sobrevida actuarial aos 5 anos foi de 97,6% para as lesões benignas e de 76,4% para as lesões malignas.</p> <span class="elsevierStyleSectionTitle">Conclusão</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Os resultados obtidos suportam a ressecção cirúrgica das lesões benignas e uma abordagem multimodal agressiva dos tumores malignos.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary cysts and tumors of the mediastinum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.J. Cohen" 1 => "L. Thompson" 2 => "F.H. Edwards" 3 => "R.F. 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| Year/Month | Html | Total | |
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