[Clinical, demographic and anatomical aspects of mediastinal masses: influence on surgical approach]

To compare clinical and demographic characteristics of patients and anatomical aspects of mediastinal masses depending on surgical approach.

A retrospective single-center study included 616 adults who underwent surgery between 2008 and 2024. Patients were divided into three groups depending on surgical approach: thoracotomy (n=420), sternotomy (n=84), and video-assisted thoracoscopic surgery (VATS) (n=112). Analysis included demographic data, tumor localization, size, volume, proximity to anatomical structures, and histological type of masses.

All patients had similar demographic and clinical characteristics. VATS was predominantly used for upper mediastinal tumors (70.5%). In the sternotomy group, 95.2% of tumors were localized in the upper mediastinum, but they were more often associated with proximity to key anatomical structures. In the thoracotomy group, tumors of the upper, posterior and middle mediastinum comprised 80.0%, 21.2% and 20.0%, respectively. Mean tumor size was smaller in the VATS group (6.8±3.8 cm) compared to the thoracotomy (8.6±4.8 cm, p=0.116) and sternotomy groups (12.1±4.6 cm, p=0.007). Similarly, tumor volume in the VATS group (0.3±0.2 dm³) was significantly smaller compared to the thoracotomy (0.6±0.4 dm³, p=0.01) and sternotomy groups (0.8±0.5 dm³, p=0.002). Thymomas were widespread in the sternotomy group (82.1%, p<0.001), while thymolipomas were more common in the VATS group (21.4%, p<0.001). Cystic masses were predominantly treated through thoracotomy (37.4%, p<0.001).

Surgical approach for mediastinal masses is determined by size, localization and topographic characteristics of tumors. Sternotomy is optimal for large tumors with proximity to major vessels and pericardium. Thoracotomy is preferable for cystic and angiomatous masses, VATS - for less invasive interventions and upper mediastinal masses.