Paravertebral tumours of the cervicothoracic junction extending into the mediastinum: surgical methods in a no man’s land.
Eur Backbone J. 2018 Feb 14;:
Authors: Prezerakos GK, Sayal P, Kourliouros A, Pericleous P, Ladas G, Casey A
PURPOSE: Cervicothoracic paravertebral neoplasms extending into the mediastinum pose a surgical problem due the complicated regional anatomy, their organic nature, rarity and surgeon’s unfamiliarity with the area. We goal to outline a surgical entry framework addressing the aforementioned complexities while attaining oncological clearance.
METHODS: We carried out a retrospective evaluation of 28 consecutive sufferers operated in two tertiary referral centres between 1998 and 2015. Pathology was positioned paravertebrally from C6 to T4 with superior mediastinum invasion. Sufferers had been operated collectively by a spinal and a thoracic surgeon.
RESULTS: Tumours had been labeled in keeping with subclavian fossa involvement as anteromedial, anterolateral and posterior and in keeping with histology in benign nerve sheath tumour group (n = 10) and malignant bone or smooth tissue tumours (n = 18). Three surgical routes had been utilised: (1) median sternotomy (n = 11), (2) anterior cervical transsternal strategy (n = 7) and (three) excessive posterolateral thoracotomy (n = 10). Resection was en bloc with broad margins in 22 circumstances, marginally full in three and incomplete in three. Problems included Horner’s syndrome (n = three), an infection (n = 2) and transient neurological deficit (n = four). Within the nerve sheath tumour group, no recurrence or reoperation happened with a median follow-up of four.5 years. Within the malignant bone and smooth tissue group, 96% of the sufferers had been alive at 1 yr, 67% at 2 years and 33% at 5 years. No vascular accidents or operative associated deaths had been noticed.
CONCLUSIONS: Classification of cervicothoracic paravertebral neoplasms with mediastinal extension in keeping with the connection with the subclavicular fossa and twin speciality involvement permits for a structured surgical strategy and supplies minimal morbidity/most resection and passable oncological outcomes. These slides might be retrieved beneath Digital Supplementary Materials.
PMID: 29445946 [PubMed – as supplied by publisher]