Department University Hospital General Thoracic Surgery, Clinical Departments Position
|Article types||case reports|
|Peer review||Peer reviewed|
|Title||Complete resection of an anterior mediastinal tumor by total arch
replacement and pulmonary artery trunk plasty with a pericardial patch
|Journal||Formal name：Annals of Medicine and Surgery|
|Domestic / Foregin||Foregin|
|Volume, Issue, Page||35,82-85頁|
|Author and coauthor||Yasuhiro Chikaishia,∗, Hiroki Matsumiyaa, Masatoshi Kanayamaa, Akihiro Tairaa, Yusuke Nabea,
Shinji Shinoharaa, Taiji Kuwataa, Masaru Takenakaa, Soichi Okaa, Ayako Hiraia, Koji Kurodaa,
Naoko Imanishia, Yoshinobu Ichikia, Yosuke Nishimurab, Fumihiro Tanakaa
|Summary||Introduction: Patients with undiagnosed anterior mediastinal tumors commonly undergo surgery for diagnosis
and treatment. However, determining the optimal therapeutic strategy is difficult for tumors with substantial
invasion, such as lesions touching the aortic arch (AA).
Case presentation: A 76-year-old man of Asian descent presented to our hospital because chest computed tomography
(CT) revealed an anterior mediastinal tumor. This tumor surrounded the left subclavian vein and
touched the AA. We suspected the tumor to be malignant. We therefore decided to resect the tumor with preparation
for total arch replacement (TAR). The operation was performed in three steps. First, we performed a
mediastinal sternotomy. However, the tumor had invaded the subclavian vein, so we resected this vein after
adding a transmanubrial approach. However, because of invading the AA we needed next step. Second, we
shifted the patient to the right lateral decubitus position. We performed partial resection of the left upper lobe
and exfoliated the distal AA. Third, we shifted the patient to the dorsal position and implanted an artificial
cardiopulmonary device, after which we performed TAR, and pulmonary artery (PA) trunk plasty with a pericardial
patch. The operation was successful, with no major adverse events. Pathologically, the tumor was diagnosed
as diffuse large B-cell lymphoma.
Discussion: If oncologically complete resection is preferable for tumors with substantial invasion, complete resection
should be attempted even if the surgery is difficult.
Conclusion: We performed complete resection of an anterior mediastinal tumor with TAR and PA trunk plasty
using a pericardial patch.