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Clamshell thoracotomy for mediastinal mass resection: technical refinements and short-term outcomes in the largest
Dong Lin1, Yue Zhang1, Defeng Ye1
1Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
The clamshell thoracotomy remains controversial for mediastinal mass resection because of its extensive exposure but significant injuries. This study evaluated its modern indications, technical refinements, and short-term outcomes at a high-volume center.
Methods:
A single-center, single-arm prospective investigation was conducted on 78 patients who underwent clamshell thoracotomy for mediastinal masses. Two CT-based radiological parameters were developed to quantify anatomical complexity. Short-term outcomes were presented and analyzed.
Results:
The cohort (median age 51 years; 71.8% male) included 68 primary tumors and 10 recurrent/metastatic tumors. The median operative time was 275 minutes, with a blood loss of 500 mL. Pulmonary resections (79.5%) and vascular reconstructions (65.4%) were frequently required. The postoperative 90-day mortality rate was 5.1%. The radiological classification was proposed as four types: A (bulky), B (hilar), C (deep-tricky), and D (mixed). Modified incisions might reduce tissue trauma without compromising exposure.
Conclusions:
Clamshell thoracotomy was essential for addressing giant or deep mediastinal tumors, particularly when vascular control or multiplanar dissection was necessary. The CT-based radiological parameters and the classification might improve preoperative planning. All these reflected a single center's experience and criteria.
