Extended resection of sarcomas involving the mediastinum: a 15-year experience†

Sarcomas involving the mediastinum are rare and aggressive tumours with a poor prognosis. We reviewed our experience to evaluate outcomes and survival for patients who undergo surgical resection.

A retrospective review of 35 patients who underwent resection of sarcomas that involved the mediastinum at a single institution over a 15-year period was conducted.

Fifteen patients (43%) had sarcomas originating from the great vessels, 15 (43%) the heart and 5 (15%) the chest wall. The most common subtype was leiomyosarcoma (n = 10, 29%). Twenty patients (57%) underwent resection of primary tumours, 11 (31%) of metastases and 4 (11%) of recurrences. Sixteen patients (46%) had Stage IV disease. An R0 resection was achieved in 17 patients (49%). Fourteen (40%) had an R1 resection and 4 (11%) an R2. Thirty cases (85%) were performed on cardiopulmonary bypass (CPB). Twenty-three patients (65%) required resection of adjacent structures. Eight cases (23%) were performed on an urgent basis. Morbidity and mortality were 37 and 6%, respectively. Overall median survival was 33 months (range 7-171 months). Median overall survival for Stage IV disease was 5 months compared with 27 months for all others (P = 0.26). Two-, 5- and 10-year survivals for the cohort were 50, 35 and 25%, respectively. Incomplete resection was associated with poor long-term survival. Median survival was 101 months for R0, 21 months for R1 and 9 months for R2 resection.

CPB and concomitant resection of intrathoracic structures may be required for local tumour control in sarcomas that involve the mediastinum, and should not be considered contraindications to resection as they may offer the best opportunity for prolonged survival in selected cases.