AB015. Perioperative outcomes and surgical strategies in malignant anterior mediastinal tumors
Original Research

AB015. Perioperative outcomes and surgical strategies in malignant anterior mediastinal tumors

Hao Jiang1, Hao Liang1, Jingfeng Zhang1, Guanying Liang2, Jianqun Ma1

1Department of Esophageal and Mediastinum, Harbin Medical University Cancer Hospital, Harbin, China; 2Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China

Correspondence to: Hao Jiang, MD, PhD. Department of Esophageal and Mediastinum, Harbin Medical University Cancer Hospital, 150 Haping Street, Harbin 150001, China. Email: jiangh1128@163.com.

Background: Malignant mediastinal tumors, despite their low incidence, often present with aggressive histology and challenging anatomical features. This study evaluated perioperative outcomes associated with different surgical approaches and explored tumor-related factors impacting surgical complexity.

Methods: A retrospective review was conducted of 27 patients with histologically confirmed malignant anterior mediastinal tumors who underwent surgical resection at our institution. Surgical approaches included open surgery (n=10), video-assisted thoracoscopic surgery (VATS, n=12), and robotic-assisted surgery (n=5). A comparative analysis was undertaken of perioperative factors such as operative duration, blood loss, intensive care unit (ICU) admission, tumor dimensions, multiorgan resection, and post-surgical complications. A correlation analysis was carried out to examine the relationship between tumor size and surgical burden

Results: Squamous cell carcinoma was the most common subtype (26%), followed by thymic carcinoma, sarcomas, mesothelioma, lymphoma, and undifferentiated malignancies. Compared to VATS (93.5±80.8 mL; 112.5±39.0 min) and robotic surgery (68.6±30.2 mL; 171.4±82.9 min), open surgery resulted in greater blood loss (640.0±940.4 mL) and longer operative time (214.5±129.5 min). ICU admission was required in 30% of open cases, but in none of the minimally invasive cases. Tumor size (mean 6.9±2.7 cm) was moderately correlated with blood loss (r=0.51) and ICU admission (r=0.37), with a weaker correlation to operative time (r=0.11) (Figure 1). Postoperative complications occurred in 33% of patients, mostly pneumonia (19%) and arrhythmia (10%), all Clavien-Dindo grade I or II. No perioperative mortality was observed.

Conclusions: Malignant mediastinal tumors are histologically diverse and often involve complex anatomical relationships. Tumor size significantly influences surgical difficulty and risk. While minimally invasive approaches like VATS offer benefits in recovery, surgical strategy should be individualized. Robotic-assisted surgery, offering both minimally invasive access and oncologic precision, may play an increasingly important role in future mediastinal tumor management.

Keywords: Anterior mediastinal tumor; perioperative outcomes; surgical approach

Figure 1 Associations between tumor size, surgical complexity, and intraoperative metrics. Top: scatter plots showing correlations between tumor size and blood loss (left) and operative time (right). Bottom: box plots comparing tumor size with multiorgan resection (left) and blood loss across surgical approaches (right). VATS, video-assisted thoracoscopic surgery.

Acknowledgments

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Footnote

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-25-ab015/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-ab015
Cite this abstract as: Jiang H, Liang H, Zhang J, Liang G, Ma J. AB015. Perioperative outcomes and surgical strategies in malignant anterior mediastinal tumors. Mediastinum 2025;9:AB015.

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