Minimalist video-assisted thoracic surgery biopsy of mediastinal tumors.
BACKGROUND
Mediastinal tumors often require surgical biopsy to achieve a precise and rapid diagnosis. However, subjects with mediastinal tumors may be unfit for general anesthesia, particularly when compression of major vessels or airways does occur. We tested the applicability in this setting of a minimalist (M) uniportal, video-assisted thoracic surgery (VATS) strategy carried out under locoregional anesthesia in awake patients (MVATS).


METHODS
We analyzed in a comparative fashion including propensity score matching, data from a prospectively collected database of patients who were offered surgical biopsy for mediastinal tumors through either MVATS or standard VATS. Tested outcome measures included feasibility, diagnostic yield, and morbidity.


RESULTS
A total of 24 procedures were performed through MVATS. Diagnostic yield was 100%. Median hospital stay and time interval to oncologic treatment were 2 days (IQR, 2-3 days) and 7 days (IQR, 5.5-11.5 days), respectively. At overall comparison (MVATS, N=24vs.VATS, N=23), there was a significant difference in both frequency and severity of postoperative complication as measured by Clavien-Dindo classification (P<0.006). In a propensity score matched comparison (8 patients per group), grade 3 or 4 complications requiring aggressive management were found only in the general anesthesia group. Global time spent in the operating room was shorter in the MVATS group (P=0.05). Time interval to oncological treatment was the same between groups. Other differences were also found in SIRS score (P=0.05) and PaO2/FiO2(P=0.04) thus suggesting better adaption to perioperative stress.


CONCLUSIONS
MVATS biopsy appears to be a reliable tool to optimize diagnostic assessment in patients with mediastinal tumors. It can offer high diagnostic accuracy due to large tissue samples, while reducing morbidity rate compared to the same operation under general anesthesia. More robust evaluation is needed to define the appropriateness of MVATS in this specific clinical setting.
Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.
Federico
F
Tacconi
Department of Respiratory Medicine, Policlinico Tor Vergata University, Rome, Italy.
Paola
P
Rogliani
Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.
Benedetto
B
Cristino
Department of Epidemiology, Tor Vergata University, Rome, Italy.
Francesco
F
Gilardi
Department of Epidemiology, Tor Vergata University, Rome, Italy.
Leonardo
L
Palombi
Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.
Eugenio
E
Pompeo
Awake video-assisted thoracic surgery (awake VATS); complication; local anesthesia; lymphoma; mediastinal tumor; non-intubated video-assisted thoracic surgery (non-intubated VATS); thoracic epidural anesthesia; video-assisted thoracic surgery (VATS)