Posterior mediastinal tumors: outcome of surgery.

BACKGROUND AND PURPOSE: The incidence of posterior mediastinal tumors relative to all tumors of the mediastinum is 23% to 30%. The posterior mediastinum is a potential space along each side of the vertebral column and adjacent proximal portion of the ribs. Primary tumors of posterior mediastinum are usually neurogenic. The aim of this study was to evaluate different surgical approaches used for the resection of posterior mediastinal tumors, and to assess morbidity, mortality and patients' survival. PATIENTS AND METHODS: Between January 2001 and January 2004, 30 patients with posterior mediastinal tumors were included. CT scan of the chest and CT guided biopsy were done for all patients; whereas MRI was done for suspected intraspinal extension. Posterolateral thoracotomy was the approach used in most of the patients. The Akwari approach was used in most of the patients with Dumbbell tumors. RESULTS: Neurogenic tumors constituted 67% of cases, being neuroblastoma in 60%. The non neurogenic tumors included a heterogenous group of rare tumors (n=10). Dumbbell tumors were found in 10 patients. Neuroblastoma was the commonest tumor to cause intraspinal extension (40%). Wide local excision was done in 13 patients; whereas extended resection was done in the remaining 17 patients. The mean intra-operative blood loss was 800cc and the mean hospital stay was 12 days. The size of the resected tumor ranged from 3 X 4 cm to 30 X 22 cm, 80% of tumors were malignant. Morbidity in relation to the procedures developed in 8 patients (atelectasis, meningitis, paraplegia, Horner syndrome and mild wound sepsis in 4, 1, 1, 1 and 1 of the patients; respectively). One postoperative mortality, due to meningitis was recorded. The overall survival by the end of three years was 87.7% with a mean survival of 30.4 months. The overall disease free survival was 55.9% with a mean disease free survival of 26.2 months. CONCLUSIONS: Posterior mediastinal tumors may reach large size before becoming symptomatic. Complete surgical excision (including adjacent invaded organs) mainly by open technique should be the rule for these patients as there is survival benefit. Great care should be taken when dealing with Dumbbell tumors.

Pleurodesis as a palliative treatment of advanced lung cancer with malignant pleural effusion.

PURPOSE: This study was conducted to evaluate the success rate of management of advanced. Lung cancer patients with malignant pleural effusion comparing talc powder with tetracycline for pleurodesis. PATIENTS AND METHODS: We report 60 patients with lung cancer associated with malignant pleural effusion treated in the department of surgery NCI, Cairo University, between January. 1998 and February, 2003. Patients were Divided Into Three Groups: Group I: Pleurodesis using tetracycline (20 patients). Group II: Pleurodesis using talc slurry (20 patients). Group III: Pleurodesis using talc insufflation (20 patients). Good response to pleurodesis is defined as no pleural fluid re-accumulation or minimal pleural fluid re-accumulation not causing symptoms or requiring further aspiration for one month. RESULTS: There were 34 males and 26 females, mean age was 54 years with range of 42-66 years, right sided effusion was present in 32 patients (53%) and left sided in 28 patients (47%). Pathological subtypes were adenocarcinoma in 32 patients, squamous cell carcinoma in 18 and undifferentiated carcinoma in 10 patients. In group I, 12 patients (60%) showed good response to intrapleural tetracycline, 15 patients (75%) responded in group II, while 17 patients (85%) showed good response in group III. Post pleurodesis complications included, fever, chest pain and empyema. CONCLUSION: It is concluded from this study that thoracoscopic talc insufflation was an effective, easy and low cost method for producing pleurodesis in patients with recurrent malignant pleural effusion and proved to be better than talc slurry and tetracycline.