Efficacy Analysis Of Thoracoscopic Surgery Via Subxiphoid Incision In The Treatment Of Mediastinal Tumors

ObjectiveTo investigate the surgical efficacy of thoracoscopic subxiphoid approach in the treatment of mediastinal tumors.MethodsA retrospective analysis was performed for patients admitted to the Department of Thoracic Surgery of the Northern Theater General Hospital of the Chinese People’s Liberation Army from 2020-9-1 to 2022-9-1 for mediastinal tumors,and patients were treated by surgical treatment of mediastinal tumors by subxiphoid or conventional thoracoscopic approach(hereinafter referred to as lateral chest wall approach),and the patients were divided into translateral chest wall approach group(n=105)and transxiphoid approach group(n=96)according to the surgical approach.Among them,95 were males and 106 were females.The average age was 53.20±12.984.Statistics were made of the maximum diameter of the patient’s tumor,BMI(body mass index),and the range of intraoperative resection.The operation time,intraoperative blood loss,postoperative chest drainage,drainage tube indwelling days,postoperative hospitalization days,whether complications occurred,and postoperative pain score at 48 hours were statistically evaluated,and the efficacy of mediastinal tumor resection via the xiphoid approach was evaluated overall.According to the general data of the patient,that is,the patient’s BMI index,maximum tumor diameter and surgical resection range,the patient’s BMI index,maximum tumor diameter and surgical resection range were divided into different subgroups,and the efficacy of subxiphoid surgery for mediastinal tumors under the influence of different preoperative factors was further analyzed among each subgroup.ResultsOverall,the operation time,intraoperative blood loss,postoperative chest drainage,postoperative indwelling drainage tube,postoperative hospitalization days,and postoperative 48 h pain scores of the subxiphoid approach were lower than those of the conventional thoracoscopic approach(P<0.05).There was no statistically significant difference between the two approaches for the development of postoperative complications.For patients with a BMI ≤ 24.77,the subxiphoid approach had a shorter surgical time,intraoperative blood loss,postoperative tube delivery days,postoperative drainage,fewer postoperative hospital days,and a lower postoperative pain score at 48hours(P<0.05).For patients with a BMI > 24.77,the operation time,intraoperative blood loss,and pain score at 48 hours postoperative with the subxiphoid approach were lower(P<0.05).For patients with a tumor diameter of ≤ 2.60,the operation time,intraoperative blood loss,and pain score at 48 hours after surgery with the subxiphoid approach were lower than those of the conventional thoracoscopic approach(P<0.05).For patients with a tumor diameter of > 2.60,the operation time,intraoperative blood loss,postoperative tube carrying days,postoperative drainage,postoperative hospitalization days,and 48-hour pain score with subxiphoid approach were less(P<0.05).In patients undergoing total thymectomy and mediastinal fat dissection,the subxiphoid approach takes less time(P<0.05).In the group undergoing simple mass resection or subtotal thymectomy,the operation time,intraoperative blood loss,number of days with tube after surgery,and pain score at 48 hours(P<0.05)were used in the subxiphoid approach.There were no statistically significant differences in the occurrence of postoperative complications for all subgroups.ConclusionFor patients who are to undergo surgical resection of anterior mediastinal mass,in general,mediastinal mass resection via the xiphoid approach has the advantages of short operation time,less intraoperative bleeding,fast postoperative recovery and low postoperative pain.For postoperative complications,there was no significant difference between the transxiphoid approach and conventional thoracoscopy.Better surgical outcomes were also shown in patients with different BMIs,different tumor maximum diameters,and different surgical resection ranges.This shows that the surgical method of resection of mediastinal tumor by subxiphoid approach is safe and effective,and surgeons can comprehensively evaluate the postoperative efficacy according to the patient’s preoperative data,and communicate with patients and their families to understand the advantages of surgical resection of mediastinal tumors by subxiphoid approach.