Mediastinal tumor resection - Revision history

Chris.Rishel at 05:44, 11 December 2023

2023-12-11T05:44:09Z

← Older revision		Revision as of 22:44, 10 December 2023
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	\| considerations_intraoperative = Lung isolation required in most cases		\| considerations_intraoperative = Lung isolation required in most cases
	\| considerations_postoperative = Epidural analgesia is recommended with open thoracotomy for postop analgesia		\| considerations_postoperative = Epidural analgesia is recommended with open thoracotomy for postop analgesia
	}}		}}A '''mediastinal tumor resection''' is a surgical procedure to remove a tumor from the mediastinum. Mediastinal tumors are characterized by their location in the mediastinum: anterior, posterior, middle. The common anterior mediastinal masses can be remembered by the "Terrible T's": thyroid (substernal goiters), thymoma, teratoma (germ cell tumors) and "terrible" lymphoma. Common masses of the middle mediastinal compartment include bronchogenic cysts, pericardial cysts, lymphomas. Common masses of the posterior compartment primarily consist of neurogenic tumors, esophageal tumors and lymphoma. The approach to resection depends on the tumor location and extent of invasion. Substernal goiters can often be removed from a superior approach from the neck. Tumors of the anterior compartment are typically handled via median sternotomy. Tumors of the middle and posterior compartment are approached best via lateral thoracotomy or VATS approaches.<ref>{{Cite book\|last=LaPar\|first=Damien\|title=Review of Cardiothoracic Surgery\|last2=Mery\|first2=Carlos\|last3=Turek\|first3=Joseph\|publisher=Thoracic Surgery Resident Association\|year=2015\|isbn=9781523217168\|location=Chicago\|pages=183-192}}</ref>

	Mediastinal tumors are characterized by their location in the mediastinum: anterior, posterior, middle. The common anterior mediastinal masses can be remembered by the "Terrible T's": thyroid (substernal goiters), thymoma, teratoma (germ cell tumors) and "terrible" lymphoma. Common masses of the middle mediastinal compartment include bronchogenic cysts, pericardial cysts, lymphomas. Common masses of the posterior compartment primarily consist of neurogenic tumors, esophageal tumors and lymphoma. The approach to resection depends on the tumor location and extent of invasion. Substernal goiters can often be removed from a superior approach from the neck. Tumors of the anterior compartment are typically handled via median sternotomy. Tumors of the middle and posterior compartment are approached best via lateral thoracotomy or VATS approaches.<ref>{{Cite book\|last=LaPar\|first=Damien\|title=Review of Cardiothoracic Surgery\|last2=Mery\|first2=Carlos\|last3=Turek\|first3=Joseph\|publisher=Thoracic Surgery Resident Association\|year=2015\|isbn=9781523217168\|location=Chicago\|pages=183-192}}</ref>

	Resection approaches also have to consider the invasion extent of the primary tumor and whether attached structures can be safely dissected away or sacrificed. Tumors with vascular invasion may require multidisciplinary approach with a cardiac surgeon and the use of cardiopulmonary bypass. In addition to posing tricky surgical considerations, large anterior mediastinal masses may also present significant anesthetic challenges. In particular, large bulky masses may compress the airway and induction of anesthesia may cause critical intrathoracic airway obstruction. Although rigid bronchoscopy may sometimes be able to bypass the obstruction and allow ventilation, often times the only safe method for ensuring ventilation on induction of anesthesia is preinduction peripheral VV-ECMO cannulation.<ref>{{Cite book\|last=Jaffe\|first=Richard\|title=Anesthesiologist's Manual of Surgical Procedure\|last2=Schmiesing\|first2=Clifford\|last3=Golianu\|first3=Brenda\|publisher=Wolters Kluwer\|year=2014\|isbn=9781451176605\|pages=308-309}}</ref>		Resection approaches also have to consider the invasion extent of the primary tumor and whether attached structures can be safely dissected away or sacrificed. Tumors with vascular invasion may require multidisciplinary approach with a cardiac surgeon and the use of cardiopulmonary bypass. In addition to posing tricky surgical considerations, large anterior mediastinal masses may also present significant anesthetic challenges. In particular, large bulky masses may compress the airway and induction of anesthesia may cause critical intrathoracic airway obstruction. Although rigid bronchoscopy may sometimes be able to bypass the obstruction and allow ventilation, often times the only safe method for ensuring ventilation on induction of anesthesia is preinduction peripheral VV-ECMO cannulation.<ref>{{Cite book\|last=Jaffe\|first=Richard\|title=Anesthesiologist's Manual of Surgical Procedure\|last2=Schmiesing\|first2=Clifford\|last3=Golianu\|first3=Brenda\|publisher=Wolters Kluwer\|year=2014\|isbn=9781451176605\|pages=308-309}}</ref>

Nquach: Filled in article

2023-12-08T18:22:09Z

Filled in article

Show changes

Chris.Rishel: Text replacement - "|Respiratory" to "|Pulmonary"

2022-02-22T05:46:39Z

Text replacement - "|Respiratory" to "|Pulmonary"

← Older revision		Revision as of 22:46, 21 February 2022
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Oliviamsutton: Created page with "{{Infobox surgical procedure | anesthesia_type = | airway = | lines_access = | monitors = | considerations_preoperative = | considerations_intraoperative = | considerati..."

2022-01-24T20:10:34Z

Created page with "{{Infobox surgical procedure | anesthesia_type = | airway = | lines_access = | monitors = | considerations_preoperative = | considerations_intraoperative = | considerati..."

New page

{{Infobox surgical procedure
| anesthesia_type =
| airway =
| lines_access =
| monitors =
| considerations_preoperative =
| considerations_intraoperative =
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Provide a brief summary of this surgical procedure and its indications here.

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
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|Neurologic
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|Cardiovascular
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|Respiratory
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|Gastrointestinal
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|Hematologic
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|Renal
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|Endocrine
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|Other
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|}

=== Labs and studies ===

=== Operating room setup ===

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===

=== Positioning ===

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
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|-
|Position
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|-
|Surgical time
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|-
|EBL
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|Postoperative disposition
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|Pain management
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|Potential complications
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|}

== References ==

[[Category:Surgical procedures]]