"Salvage" surgery for primary mediastinal malignancies: is it worthwhile?
BACKGROUND
Indications and results of salvage surgery in mediastinal tumors are still unclear. This study analyzes a single-center experience to assess its mortality, morbidity, and long-term results.


METHODS
Mediastinal salvage surgery (MSS) was defined as surgical resection of persistent or recurrent primary mediastinal tumors after previous local treatments with curative intent or exclusive chemotherapy in case of bulky tumors. Clinical data of patients undergoing MSS between 1998 and 2005 were analyzed. Overall and disease-specific long-term survival was calculated.


RESULTS
Twenty-one patients (15 men and 6 women, mean age 41 years) underwent MSS. Eleven patients suffered from thymic tumors (eight thymomas, three thymic carcinoma) whereas 10 patients suffered from nonthymic tumors (one lung adenocarcinoma + thymoma, two mediastinal monophasic sinovial sarcoma, one mediastinal neuroendocrine tumor, one mediastinal teratoblastoma, one mediastinal disgerminoma, one Hodgkin's lymphoma, one mediastinal atypic carcinoid, two medullary thyroid carcinoma). MSS required extended vascular resection in 10 cases and cardiopulmonary bypass in one case. Median operation time was 215 minutes (range 140-720). One postoperative death and four major complications were recorded (overall mortality 4.7%, morbidity 19.0%). With a median follow-up of 30.6 months, overall 1-, 3-, and 5-year Kaplan-Meier survival was 89.7, 71.2, and 56.6%, respectively. Thymic neoplasms had a better prognosis (1-, 3-, and 5-year survival was 100, 87.5, 87.5%, respectively) when compared with others (1-, 3-, and 5-year survival was 77.8, 53.3, 26.7%, respectively--logrank p = 0.0128).


CONCLUSIONS
MSS can offer a chance of curative treatment in selected patients with an acceptable morbidity and mortality. Thymic tumors obtain the best results in term of long-term survival.
Petrella
Francesco
F
Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy. francesco.petrella@ieo.it
Leo
Francesco
F
Veronesi
Giulia
G
Solli
Piergiorgio
P
Borri
Alessandro
A
Galetta
Domenico
D
Gasparri
Roberto
R
Lembo
Rosalba
R
Radice
Davide
D
Scanagatta
Paolo
P
Spaggiari
Lorenzo
L
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000473:pathology / Q000601:surgery; D004407:Dysgerminoma / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000473:pathology / Q000601:surgery; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008479:Mediastinal Neoplasms / Q000145:classification* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D012509:Sarcoma / Q000473:pathology / Q000601:surgery; D016019:Survival Analysis; D013724:Teratoma / Q000473:pathology / Q000601:surgery; D013945:Thymoma / Q000473:pathology / Q000601:surgery; D013953:Thymus Neoplasms / Q000473:pathology / Q000601:surgery; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome