Surgical Treatment For Thoracic Tumor Invading The Heart Or Great Vessels

Objective:To discuss the experience of surgical treatment for thoracic tumor invading the heart (include pericardium) or great vessels. To analyze and research the experience include the case selection of surgery, the preparation during perioperative period, the management of postoperative complications and intraoperative anesthesia, and the surgical approachs, decisions of resection type and extent etc.Methods:A retrospective analysis of 54 cases of thoracic tumor invading the heart (include pericardium) or great vessels. I.Incision:20 cases of mid-sternal incision combined with 1 case of the small collar incision,15 cases of right chest posterolateral incision,14 cases of left chest postero-lateral incision,2 cases of left anterior outboard incision,1 case of right anterior outboard incision,1 case of right midaxillary line incision between 4th and 5th costa,1 case of two incisions of right chest and upper middle abdomen.â…¡.Anesthesia:54 cases of intravenous inhalational anesthesia,40 cases combined with the continuous epidural anesthesia,1 case of cardiopulmonary bypass (CPB).â…¢. Surgical approachs:All cases received tumor resection. Among them, there are 36 cases of partial pericardiectomy, 19 cases of partial atrium and major vessels reconstruction,11 cases of sleeve lobectomy combined with sleeve pulmonary artery resection,9 cases of unilateral phrenectomy,8 cases of partial lung resection,5 cases of total resection pneumonectomy,5 cases of the aortic adventitia resection,2 cases of the tracheal carina reconstruction and plasty,1 case of unilateral vagectomy,1 case of CPB.52 cases were performed by radical tumor resection, and 2 cases of stump-positive, one has no option but to unilateral phrenectomy and the other lateral residual tumor because that bilateral phrenic nerve are invaded by tumor.Results:All the patients underwent the operation successfully, the average operation duration was 192 minutes, mean operative blood loss was 302 ml, the average time of superior vena cava occlusion was 25-35 minutes, the average time with drainage tubes was 3.89 days, the average amount of drainage daily was 230.95 ml (Except that one case of postoperative active hemorrhage underwent reoperation and combined with severe hypopro-teinemia, the average amount of drainage daily was 800 ml). Specimens size (maximum diameter) was 3cm-15cm. The average time of tracheal intubation and assist breathing with ventilator of 6 cases were 1.5 days (Except that 1 case myasthenia gravis of assist breathing with ventilator, the time was 11 days). The median postoperative stay was 16 days. Complications:Pleural effusion in 10 patients (18.52%), arrhythmia in 10 patients (18.52%), pulmonary infection in 5 cases (9.26%), chest active hemorrhage in 2 cases (3.70%), and atelectasis in 1 case (1.85%), deep vein thrombosis in 1 case (1.85%), severe hypoproteinemia in 1 case (1.85%), Death (pulmonary embolism) in 1 case (1.85%). Incision II/A healed. Follow-up 6 to 96 months, the mediastinal tumor group:1-year survival rate of 85.19%(23/27),3-year survival rate of 62.50%(10/16),5-year survival rate of 57.14%(4/7).1 case survival time was 6 years and 2 cases survival time were 8 years, which all were malignant thymoma. Lung Cancer Group:1-year survival rate of 72.00%(18/25),3-year survival rate of 50.00%(10/20),5-year survival rate of 33.33%(3/9). Local recurrence in 1 case.1 case of esophageal cancer:Survived 3 years and 5 months.Conclusion:The proper selection of operation and intraoperative treatment for tumor invading the heart or great vessels not only can be performed to radical resection but also provide more chances to radiotherapy or chemotherapy, so it is benefit for improving living quality and survival time of patients.