AB004. Optimizing surgical strategies in mediastinal tumor resections through comparative analysis of hemi-clamshell and sternotomy techniques
Original Research

AB004. Optimizing surgical strategies in mediastinal tumor resections through comparative analysis of hemi-clamshell and sternotomy techniques

Chengyuan Fang1,2, Jingle Lei2, Xiaodong Ling2, Yingnan Yang2, Huiying Li3, Jianqun Ma2

1Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; 2Department of Esophageal and Mediastinum, Harbin Medical University Cancer Hospital, Harbin, China; 3Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China

Correspondence to: Chengyuan Fang, PhD. Department of Biomedical Engineering, University of Michigan, 1150 W Medical Center Drive, Ann Arbor, MI 48109-5622 USA; Department of Esophageal and Mediastinum, Harbin Medical University Cancer Hospital, Harbin, China. Email: chengyuf@umich.edu.

Background: Anterior mediastinal tumors near critical vascular structures present significant surgical challenges. Traditional median sternotomy, often complicated by limited access and visibility, can impede complete tumor excision. Conversely, the hemi-clamshell incision has shown potential in reducing surgical trauma and enhancing visibility, thereby improving resection outcomes. This study compares the perioperative outcomes of the hemi-clamshell technique with those of conventional median sternotomy.

Methods: This retrospective study from January to December 2023 involved fourteen patients, equally divided between those undergoing mediastinal tumor resections via hemi-clamshell or conventional sternotomy. We evaluated perioperative parameters such as surgery duration, intraoperative blood loss, hospital stay, complication rates, and tumor dimensions.

Results: The hemi-clamshell group had marginally longer surgery times, averaging 188.57±42.92 minutes compared to 177.29±36.88 minutes for the sternotomy group. However, it significantly reduced intraoperative blood loss, averaging 192.86±94.22 versus 264.29±182.67 mL for sternotomy. Tumor sizes were similar between groups, measuring 6.929±3.09 cm for hemi-clamshell and 7.36±2.72 cm for sternotomy. Hemi-clamshell patients also had shorter postoperative hospital stays, averaging 6.29±1.50 days compared to 8.86±1.86 days for sternotomy (Figure 1). In terms of complications categorized as Grade II, the hemi-clamshell group had two patients with manageable complications, one with pneumonia and another with both pneumonia and a surgical site infection. In comparison, five patients in the sternotomy group experienced complications, including two with pneumonia and three with arrhythmias, all of which were managed medically.

Conclusions: Both hemi-clamshell and sternotomy techniques are effective for mediastinal tumor resections. However, the hemi-clamshell approach offers significant advantages in reducing intraoperative blood loss and shortening recovery times, suggesting better patient outcomes. It also has a lower complication rate, highlighting its safety profile. Tailored surgical planning, considering individual patient conditions, is recommended. Further research with larger cohorts is needed to confirm these findings and refine surgical practices for complex mediastinal tumors.

Keywords: Hemi-clamshell; mediastinal tumor; perioperative outcome

Figure 1 Comparison of perioperative parameters between the sternotomy and hemi-clamshell approaches. Bar graphs show mean ± standard deviation for surgery duration (minutes), tumor size (cm), blood loss (mL), postoperative hospital stay (days), and overall hospital stay (days).

Acknowledgments

None.

Footnote

Funding: This work was supported by Haiyan Foundation of Harbin Medical University Cancer Hospital (No. JJQN2022-13).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-25-ab004/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the institutional Ethics Committee of Harbin Medical University Cancer Hospital (No. 2020-50-IIT) and individual consent for this retrospective analysis was waived.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/med-25-ab004
Cite this abstract as: Fang C, Lei J, Ling X, Yang Y, Li H, Ma J. AB004. Optimizing surgical strategies in mediastinal tumor resections through comparative analysis of hemi-clamshell and sternotomy techniques. Mediastinum 2025;9:AB004.

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