Thoracoscopic resection as the preferred approach to posterior mediastinal neurogenic tumors

Traditionally, resection of posterior mediastinal neurogenic tumors (PMNTs) has been through a posterolateral thoracotomy. Although thoracoscopic resection of these tumors has been advocated, treatment guidelines have not been reported previously. The authors report a thoracoscopic resection of a PMNT and conducted a retrospective review of similar cases in the literature. Successful thoracoscopic resection was compared with tumor size and type using a nonpaired t test (alpha: P < 0.05). A total of 29 patients (13 men, 16 women), aged 26 to 68 years, who underwent a thoracoscopic resection of a PMNT were identified. Preoperative imaging included chest radiography and computed tomography in all patients and magnetic resonance imaging in 15 of 29 patients (52%). All tumors were located in the posterior mediastinum without preoperative evidence of invasion or malignancy. Conversion to an open procedure was necessitated in 12 of 29 (41%) patients ("minithoracotomy" in 11, posterolateral thoracotomy in 1). Tumor size necessitating conversion to an open procedure (mean = 4.79 cm) and tumor size amenable to thoracoscopy alone (mean = 3.84 cm) were not significantly different (P < 0.09). Pathology revealed 22 schwannomas (76%), 6 ganglioneuromas (21%), and 1 malignant schwannoma (3%) and was not associated with conversion to an open procedure (P < 0.99). Thoracoscopic resection of PMNTs can be performed successfully, regardless of tumor type or size; however, malignancy, local invasion, and tumors >5 cm may require an open procedure. Thoracoscopic resection can replace thoracotomy in the treatment of PMNTs.