Effect of surgical management for anterior mediastinal large mass: a retrospective cohort study

Minimally invasive surgery for anterior mediastinal mass with a maximum diameter greater than 5 cm remains challenging. This study assessed perioperative outcomes based on the 5-cm size threshold to determine if large tumors can be safely managed thoracoscopically.

This retrospective cohort study included 40 patients with anterior mediastinal masses who underwent surgical management between March 2015 and November 2024. Patients were stratified by the maximum tumor diameter on computed tomography scans: those with a diameter ≥5 cm constituted Group I (n=19), and those with a diameter <5 cm constituted Group II (n=21). Demographic, clinical, perioperative, and short-term outcome data were collected and compared between the cohorts.

In Group I (n=19), the surgical approaches comprised trans-subxiphoid thoracoscopy in 10 cases, trans-intercostal thoracoscopy in 5 cases, transverse sternotomy in 2 cases, median sternotomy in 1 case, and posterolateral thoracotomy in 1 case; R0 resection was achieved in 16 cases, with R2 resection in the remaining 3. In Group II (n=21), procedures included trans-subxiphoid thoracoscopy in 19 cases, trans-intercostal thoracoscopy in 1 case, and a transverse cervical incision in 1 case; R0 resection was accomplished in all 21 patients, although two cases were converted to open surgery. The postoperative hospital stay was significantly longer in Group I compared to Group II. No significant differences were found between the two groups in operating time, rate of conversion to open surgery, or degree of resection.

Our findings suggest that tumor size ≥5 cm alone may not be an absolute contraindication for thoracoscopic surgery. Preoperative assessment of potential extratumoral invasion and risk of major hemorrhage appear to be more critical factors in selecting the surgical approach.