Surgical Management for the Patients of Mediastinal Malignancy Involving Cardiac Structures with Circulatory Impairments

(Division of Organ Regeneration Surgery, Faculty of Medicine, Tottori University, Yonago, Japan and Department of Cardiovascular Surgery, Hamada Medical Center*, Hamada, Japan)

Yasunori Cho* Satoru Suzuki Yoshiyuki Haga
Kenichi Hashizume
Malignant disease in the mediastinum often involves cardiac structures such as the cardiac chamber and great vessels, and causes circulatory impairments that limit therapeutic options and longevity. In the present study, we evaluated curative or palliative surgical management for 6 cases of such malignancy in the mediastinum with circulatory impairment who were operated on between January 2001 and February 2004 (4 men and 2 women aged 17 to 72 years). Procedures included tumor resection with cardiopulmonary bypass (CPB) for mitral strangulation due to left atrial myxosarcoma; pericardiectomy without CPB for constrictive pericarditis due to invasive thymoma; radical nephrectomy for renal cell carcinoma with right atrial tumor thrombus using CPB; two pericardial fenestrations with or without partial tumor resection for cardiac tamponade due to pericarditis carcinomatosis caused by malignant lymphoma or lung cancer; and right ventricular metastatic lesion resection with outflow tract reconstruction for the recurrence of renal cell carcinoma using CPB. The follow-up ranged from 4 days to 30 months. Procedure-related death occurred in the patient with invasive thymoma due to heart failure on postoperative day 4. Five operative survivors had improved quality of life and received other therapeutic options. Although the patient with malignant lymphoma died of sepsis during chemotherapy at three weeks, the remaining 4 patients were discharged from the hospital postoperatively but 3 died during follow-up due to the progression of malignant disease. The cause of death were local recurrence at 20 months after operation in the patient with myxosarcoma, liver metastasis at 13 months in the renal cell carcinoma patient, and carcinomatous cachexia at 8 months in the patient with metastatic lung cancer. The patient with recurrence of renal cell carcinoma is doing well without any symptoms of tumor progression at 30 months after metastatic lesion rsection. Despite poor prognosis of the patients of mediastinal malignancy, surgical management for circulatory impairments can be indicated with acceptable risk to lengthen survival and improve the quality of life.
@Jpn. J. Cardiovasc. Surg. 35: 10-13 (2006)