AB027. Insights into hemi-clamshell incision for mediastinal tumor resection
Abstract

AB027. Insights into hemi-clamshell incision for mediastinal tumor resection

Chengyuan Fang1,2, Yuwen Bai1, Yanzhong Xin1, Luquan Zhang1, Jianqun Ma1

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

Correspondence to: Chengyuan Fang, MD. Department of Esophageal and Mediastinum, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150001, China; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA. Email: chengyuf@umich.edu.

Background: This study outlines the utilization of the hemi-clamshell incision technique in the surgical treatment of mediastinal tumors across seven patients in Department of Esophageal and Mediastinum of Harbin Medical University Cancer Hospital. The hemi-clamshell incision has demonstrated itself as a robust and efficient approach for resecting complex mediastinal masses, providing enhanced exposure and surgical management. The procedure exhibited a favorable safety profile and yielded satisfactory clinical outcomes, supporting its use in carefully selected patients confronting challenging mediastinal masses.

Methods: Between January 2023 and December 2023, seven patients aged 37 to 67 years with mediastinal tumors underwent resection via the hemi-clamshell incision. The procedure initiates with a partial median sternotomy, followed by an incision on the appropriate side and intercostal space depending on tumor location, facilitating extensive exposure of the anterior and superior mediastinum. Furthermore, the technique of suspending and securing the split sternum, developed by our department, enabled optimal and efficient exposure of the surgical field.

Results: Among the seven patients, five underwent left thoracotomy and two underwent right thoracotomy. Six patients had their sternum transected at the third intercostal space, while one patient had it transected at the second intercostal space due to a higher tumor location. The average intraoperative time was 188.8 minutes. All patients underwent en-bloc resection. Postoperative pathologies varied, including one case each of poorly differentiated squamous cell carcinoma of thymic origin, mucinous adenocarcinoma, neurilemmoma, nodular goiter, AB type thymoma, and there were two cases of mature cystic teratoma. The average hospital stay was 6.3 days. All patients were transferred to the general ward post-surgery, and none required admission to the intensive care unit (ICU). The average time to mobilization was 3 days, with an average chest tube retention time of 4 days. There were no serious postoperative complications.

Conclusions: The hemi-clamshell incision offers several advantages over traditional sternotomies and thoracotomies, particularly in terms of enhanced exposure and access. Our experience indicates that this technique is effective for resecting complex mediastinal tumors, achieving a balance between extensive exposure and patient safety. The ability to achieve complete resection with clear margins represents a significant advantage, contributing to favorable oncological outcomes.

Keywords: Hemi-clamshell; mediastinal tumor; surgery

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-24-ab027/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 (as revised in 2013). The study was approved by the Ethics Committee of Harbin Medical University Cancer Hospital (No. 2021-49-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-24-ab027
Cite this abstract as: Fang C, Bai Y, Xin Y, Zhang L, Ma J. AB027. Insights into hemi-clamshell incision for mediastinal tumor resection. Mediastinum 2024;8:AB027.

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