Management of large anterior mediastinal mass by video-assisted thoracoscopic surgery

There are controversies regarding managing anterior mediastinal mass greater than 5 cm by video-assisted thoracoscopic surgery (VATS). This study aims to present a single-center experience in using VATS to resect large anterior mediastinal masses using either unilateral or bilateral approach.

This is a retrospective case series, including consecutive patients referred for surgical management of anterior mediastinal mass, provided the mass was equal to or larger than five centimeters. Only phase I (unilateral VATS) was performed for those with a single approach, while phase one and phase II (bilateral VATS) were performed for those with dual approach.

The study included eight cases; 4 (50%) were male, and 4 (50%) were female. All of the cases had features of myasthenia gravis. The average diameter of the mass on the computed tomography scan was 7 cm, ranging from 5 to 12 cm. Dual VATS was utilized in three (37.5%) cases, which showed both left and right extension. The average blood loss was 180 ml, ranging from 130 to 250 ml. All of the cases were thymoma. Complete resection was achieved in all cases with R0. Neither mortality nor recurrence was reported in the follow-up period (14 months average ranging from 6 to 36 months).

VATS is a safe and effective approach for large anterior mediastinal masses, with satisfactory operative outcomes, minimal morbidity, and promising oncological results. Dual VATS may be particularly useful for lesions with significant bilateral extension.