Comparison Of Clinical Outcomes Between The Subxiphoid And Chest Wall Approaches In Performing Video-assisted Thoracoscopic Mediastinal Masses Resection

Objectives: To evaluate the feasibility,safety and short-term outcomes of the subxiphoid approach for video-assisted thoracoscopic mediastinal masses resection in treating mediastinal masses.Methods : We retrospectively analyzed clinical data of 106 patients who underwent video-assisted thoracoscopic mediastinal masses resection by one surgical team in Fujian Medical University Union Hospital from June 2014 to December 2015.we divided all patients into two groups according to the different surgical approaches,including 47 patients who underwent subxiphoid video-assisted thoracoscopic mediastinal masses resection(Sx VAT group) and 59 patients who underwent chest wall video-assisted thoracoscopic mediastinal masses resection(CWVAT group). The perioperative outcomes,postoperative complication, short-term recurrence rate and survival were compared between the two groups.Results : All the 106 patients who underwent video-assisted thoracoscopic mediastinal masses resection, including 47 cases underwent subxiphoid approach and59 cases underwent chest wall approach. There was no significant difference comparing the demographic characteristics between two groups(P=0.075).And the location of the mediastinal masses of two groups is primary in the anterior mediastinum(91.5% patients of Sx VAT group and 74.6% patients of CWVAT group).The second is superior mediastinum and posterior mediastinum. There was no statistical significant differences in messes size, operation time, intraoperative blood loss, blood transfusions, pulmonary infection, postoperative hospital stay, hospital cost and other complications between two groups.The drainage volume, postoperative pleural drainage duration of Sx VAT group was significantly less than CWVAT group(150±155ml VS 350±400ml P<0.01, 2.45±1.04 days VS 2.9±1.15 daysP=0.039, respectively). The percentage of intravenous use of painkillers and the duration of employment, the pain score of the third month postoperatively for the Sx VAT and CWVAT groups were respectively 17.0% versus 62.7%(P<0.01),0.43±0.99 days versus 2.09±1.68 days(P<0.01), 0±0 point versus 2±1 points(P<0.01). There was no perioperative death between two groups, and the total complications of postoperative was 16.0%(17/106). There was no statistical difference in postoperative complications between two groups(14.9% versus 16.9respectively, P=0.774). One patient with postoperative bleeding and blood transfusion appeared in CWVAT group,but none case in Sx VAT group. 106 patients(96.2%)were followed up from 2—20 months(median 9.5±10 months). There was no statistical difference regard to short-term recurrence rate and survival between CWVAT group and Sx VAT group(0% versus 3.6% p=0.203,100% versus98.2%).Conclusions:Our research revealed that both subxiphoid and chest wall video-assisted thoracoscopic mediastinal masses resection have a satisfactory outcomes.Although retrosternal operation space is narrow and it requires a good teamwork,but subxiphoid approach video-assisted thoracoscopic mediastinal masses resection has less drainage volume,shorter extubation time, less pain, a better view of the bilateral pleural cavities and with good cosmesis.It is technically feasible, safe and satisfactorily short-term outcomes.Additional follow-up is required to evaluate the long-term outcomes.