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Surgery for Mediastinal Disease in the Elderly

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Cardiothoracic Surgery in the Elderly
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Abstract

Mediastinal masses present throughout the decades of life but certainly occur with relative frequency in the older population. Furthermore, with the increasing ­frequency of obtaining pulmonary embolism chest CT scans, there are more incidentally discovered mediastinal abnormalities that require investigation. Relatively common ­conditions encountered include substernal and intrathoracic goiters, anterior mediastinal masses suspicious for lymphoma, mediastinal lymphadenopathy, thymomas, and ­posterior mediastinal neurogenic tumors. Mediastinal cysts-pericardial, bronchogenic, and esophageal duplication are all uncommon in the elderly, rarely require any treatment in the elderly population and so will not be discussed.

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References

  1. Engels EA, Pfeiffer RM. Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer. 2003;105:546–51.

    Article  PubMed  CAS  Google Scholar 

  2. Morgenthaler TI, Brown LR, Colby TV, Harper CM Jr, Coles DT. Thymoma. Mayo Clin Proc. 1993;68:1110–23.

    Article  PubMed  CAS  Google Scholar 

  3. Suadjian JV, Enriquez P, Silverstein MN, Pepin JM. The spectrum of diseases associated with thymoma: coincidence or syndrome? Arch Intern Med. 1974;154:374–9.

    Google Scholar 

  4. Voltz RD, Albrich WE, Nagele A, Schumm F, Wick M, Freiberg A, et al. Paraneoplastic myasthenia gravis: detection of anti-MGT30 (titin) antibodies predicts thymic epithelial tumor. Neurology. 1997;49:1454–7.

    Article  PubMed  CAS  Google Scholar 

  5. Gautel M, Lakey A, Barlow DP, Holmes Z, Scales S, Leonard K, et al. Titin antibodies in myasthenia gravis: identification of a major immunogenic region of titin. Neurology. 1993;43:1581–5.

    Article  PubMed  CAS  Google Scholar 

  6. Bulkley GB, Bass KN, Stephenson R, Diener-West M, George S, Reilly PA, et al. Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis. Ann Surg. 1997;226:324–35.

    Article  PubMed  CAS  Google Scholar 

  7. Cumming WJK, Hudgeson P. The role of plasmapheresis in preparing patients with myasthenia for thymectomy. Muscle Nerve. 1986;9:S155–8.

    Article  Google Scholar 

  8. Mulder DM. Extended transsternal thymectomy. In: Shields TW, editor. General thoracic surgery. 5th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2000. p. 2233–7.

    Google Scholar 

  9. Kubota K, Yamada S, Kondo T, Yamada K, Fukuda H, Fujiwara T, et al. PET imaging of primary mediastinal tumours. Br J Cancer. 1996;73:882–6.

    Article  PubMed  CAS  Google Scholar 

  10. Kesler KA, Rieger KM, Ganjoo KN, Sharma M, Fineberg NS, Einhorn LH, et al. Primary mediastinal nonseminomatous germ cell tumors: the influence of postchemotherapy pathology on ­long-term survival after surgery. J Thorac Cardiovasc Surg. 1999;118:692–701.

    Article  PubMed  CAS  Google Scholar 

  11. Maggi G, Casadio C, Cavallo A, Cianci R, Molinatti M, Ruffini E, et al. Thymoma: results of 241 operated cases. Ann Thorac Surg. 1991;51:152–6.

    Article  PubMed  CAS  Google Scholar 

  12. Morrissey B, Adams H, Gibbs AR, Crane MD. Percutaneous needle biopsy of the mediastinum: review of 94 procedures. Thorax. 1993;48:632–7.

    Article  PubMed  CAS  Google Scholar 

  13. Okumura M, Ohta M, Tateyama H, Nakagawa K, Matsumura A, Maeda H, et al. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients. Cancer. 2002;94:624–32.

    Article  PubMed  Google Scholar 

  14. Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymoma with special reference to their clinical stages. Cancer. 1981;48:2485–92.

    Article  PubMed  CAS  Google Scholar 

  15. Masaoka A, Yamakawa Y, Niwa H, Fukai I, Saito Y, Tokudome S, et al. Thymectomy and malignancy. Eur J Cardiothorac Surg. 1994;8:251–3.

    Article  PubMed  CAS  Google Scholar 

  16. Schneider PM, Fellbaum C, Fink U, Bollschweiler E, Präuer HW. Prognostic importance of histomorphologic subclassification for epithelial thymic tumors. Ann Surg Oncol. 1996;4:46–56.

    Article  Google Scholar 

  17. Nakagawa K, Asamura H, Matsuno Y, Suzuki K, Kondo H, Maeshima A. Thymoma: a clinicopathologic study based on the new World Health Organization classification. J Thorac Cardiovasc Surg. 2003;126:1134–40.

    Article  PubMed  Google Scholar 

  18. Port JL, Ginsberg RJ. Surgery for thymoma. Chest Surg Clin N Am. 2001;11:421–37.

    PubMed  CAS  Google Scholar 

  19. Kaiser LR. Thymoma. The use of minimally invasive resection techniques. Chest Surg Clin N Am. 1994;4(1):185–94.

    PubMed  CAS  Google Scholar 

  20. Roviaro G, Rebuffat C, Varonli F, Vergani C, Maciocco M, Scalambra SM. Videothoracoscopic excision of mediastinal masses: indications and techniques. Ann Thorac Surg. 1994;58:1679–84.

    Article  PubMed  CAS  Google Scholar 

  21. Landreneau RJ, Dowling RD, Castillo W, Ferson PT. Thoracoscopic resection of an anterior mediastinal tumor. Ann Thorac Surg. 1992;54:142–4.

    Article  PubMed  CAS  Google Scholar 

  22. Acuff TE, Mack MJ, Ryan WH, Bowman RT, Douthit MB. Thoracoscopic thymoma resection [comment]. Ann Thorac Surg. 1993;55(2):562–3.

    Article  PubMed  CAS  Google Scholar 

  23. Curran WJ, Kornstein FJ, Brooks JJ, Turrisi AT. Invasive thymoma: the role of mediastinal irradiation following complete or incomplete surgical resection. J Clin Oncol. 1988;6:1722–7.

    PubMed  Google Scholar 

  24. Pollack A, Komaki R, Cox JD, Ro JW, Oswald M, Shin DM, et al. Thymoma: treatment and prognosis. Int J Radiat Oncol Biol Phys. 1992;23:1037–43.

    Article  PubMed  CAS  Google Scholar 

  25. Ogawa K, Uno T, Toita T, Onishi H, Yoshida H, Kakinohana Y, et al. Postoperative radiotherapy for patients with completely resected ­thymoma. Cancer. 2002;94:1405–13.

    Article  PubMed  Google Scholar 

  26. Haniuda M, Morimoto M, Nishimura H, Kobayashi O, Yamanda T, Iada F, et al. Adjuvant radiotherapy after complete resection of ­thymoma. Ann Thorac Surg. 1992;54:311–5.

    Article  PubMed  CAS  Google Scholar 

  27. Mangi AA, Wright CD, Allan JS, Wain JC, Donahue DM, Grillo HC, et al. Adjuvant radiation therapy for stage II thymoma. Ann Thorac Surg. 2002;74:1033–7.

    Article  PubMed  Google Scholar 

  28. Singhal S, Shrager JB, Rosenthal DI, LiVolsi VA, Kaiser LR. Comparison of stages: thymoma treated by complete resection with or without adjuvant radiation. Ann Thorac Surg. 2003;76:1635–42.

    Article  PubMed  Google Scholar 

  29. Kondo K, Monden Y. Therapy for thymic epithelial tumors: a ­clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003;76:878–85.

    Article  PubMed  Google Scholar 

  30. Thomas CR, Wright CD, Loehrer PJ. Thymoma: state of the art. J Clin Oncol. 1999;17:2280–9.

    PubMed  CAS  Google Scholar 

  31. Loehrer PJ, Kim KM, Aisner SC, Livingston R, Einhorn LH, Johnson D, et al. Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial. J Clin Oncol. 1994;12:1164–8.

    PubMed  Google Scholar 

  32. Macchiarini P, Chella A, Ducci F, Rossi B, Testi C, Bevilacqua G, et al. Neoadjuvant chemotherapy, surgery and postoperative radiation therapy for invasive thymoma. Cancer. 1991;68:706–13.

    Article  PubMed  CAS  Google Scholar 

  33. Berruti A, Borasio P, Gerbino A, Gorzegno G, Moschini T, Tampelli M, et al. Primary chemotherapy with adriamycin, cisplatin, vincristine and cyclophosphamide in locally advanced thymomas: a single institution experience. Br J Cancer. 1999;81:841–5.

    Article  PubMed  CAS  Google Scholar 

  34. Rea F, Sartori F, Loy M, Calabro F, Fornasiero A, Danile O, et al. Chemotherapy and operation for invasive thymoma. J Thorac Cardiovasc Surg. 1993;106:543–9.

    PubMed  CAS  Google Scholar 

  35. Shin DM, Walsh GL, Komaki R, Putnam JB, Nesbitt J, Ro JY, et al. A multidisciplinary approach to therapy for unresectable malignant thymoma. Ann Intern Med. 1998;129:100–4.

    PubMed  CAS  Google Scholar 

  36. Kim ES, Putnam JB, Komaki R, Walsh GL, Ro J, et al. A phase II study of a multidisciplinary approach with induction chemotherapy followed by surgical resection, radiation therapy and consolidation chemotherapy for unresectable malignant thymomas: final report. Proc Am Soc Clin Oncol. 2001;20:310A.

    Google Scholar 

  37. Loehrer PJ, Chen M, Kim K, Aisner SC, Einhorn LH, Livingston R, et al. Cisplatin, doxorubicin and cyclophosphamide plus thoracic radiation therapy for limited-stage unresectable thymoma: an intergroup trial. J Clin Oncol. 1997;15:3093–9.

    PubMed  CAS  Google Scholar 

  38. Venuta F, Rendino EA, Longo F, Giacomo TD, Anile M, Mercadante E, et al. Long term outcome after multimodality ­treatment for stage III thymic tumors. Ann Thorac Surg 2003;76:1866–72.

    Google Scholar 

  39. Lucchi M, Ambrogi M, Duranti L, Basolo F, Fontanini G, Angeletti CA. Advanced stage thymomas and thymic carcinomas: results of multimodality treatment. Ann Thorac Surg 2005;79:1840–4.

    Google Scholar 

  40. Yagi K, Hirata T, Fukuse T, Yokomise H, Inui K, Ike O, et al. Surgical treatment for invasive thymoma, especially when the ­superior vena cava is invaded. Ann Thorac Surg. 1996;61:521–4.

    Article  PubMed  CAS  Google Scholar 

  41. Akaogi E, Ohara K, Mitsui K, Onizuka M, Ishikawa S, Mitsui T, et al. Preoperative radiotherapy and surgery for advanced thymoma with invasion to the great vessels. J Surg Oncol. 1996;63:17–22.

    Article  PubMed  CAS  Google Scholar 

  42. Wright CD, Wain JW, Wong DR, Donahue DM, Gaissert HA, Grillo HC, et al. Predictors of recurrence in thymic tumors; Importance of invasion, WHO histology and suze. J Thorac Cardiovasc Surg 2005;130:1413–21.

    Google Scholar 

  43. Okumura M, Miyoshi S, Takeuchi Y, Yoon H, Minami M, Takeda S, et al. Results of surgical treatment of thymomas with special ­reference to the involved organs. J Thorac Cardiovasc Surg. 1999;117:605–13.

    Article  PubMed  CAS  Google Scholar 

  44. Nakahara K, Ohno K, Hashimoto J, Maeda H, Miyoshi S, Sakurai M, et al. Thymoma: results with complete resection and adjuvant postoperative irradiation in 141 consecutive patients. J Thorac Cardiovasc Surg. 1988;95:1041–7.

    PubMed  CAS  Google Scholar 

  45. Budde JM, Morris CD, Gal AA, Mansour KA, Miller JI. Predictors of outcome in thymectomy for myasthenia gravis. Ann Thorac Surg. 2001;72:197–202.

    Article  PubMed  CAS  Google Scholar 

  46. Maggi G, Casadio C, Cavallo A, Molinatti M, Ruffini E. Thymectomy in myasthenia gravis: results of 662 cases operated upon in 15 years. Eur J Cardiothorac Surg. 1989;3:504–11.

    Article  PubMed  CAS  Google Scholar 

  47. de Perrot M, Liu J, Bril V, McRae K, Bezjak A, Keshavjee SH. Prognostic significance of thymomas in patients with myasthenia gravis. Ann Thorac Surg. 2002;74:1658–62.

    Article  PubMed  Google Scholar 

  48. Regnard JF. Magdeleinat P. Dromer C, Dulmet E, DeMontpreville V, Levi JF, et al. Prognostic factors and long-term results after ­thymoma resection: a series of 307 patients. J Thorac Cardiovasc Surg. 1996;112:376–84.

    Article  PubMed  CAS  Google Scholar 

  49. Wilkins EW Jr, Grillo HC, Scannell JG, Moncure AC, Mathisen DJ. Role of staging in prognosis and management of thymoma. Ann Thorac Surg. 1991;51:888–92.

    Article  PubMed  Google Scholar 

  50. Hashmi SM, Premachandra DJ, Bennett AMD, Parry W. Management of retrosternal goiters: results of early surgical intervention to prevent airway morbidity, and a review of the English literature. J Laryngol Otol. 2006;120:644–9.

    Article  PubMed  CAS  Google Scholar 

  51. White ML, Doherty GM, Gauger PG. Evidence based surgical management of substernal goiter. World J Surg. 2008;32:1285–300.

    Article  PubMed  Google Scholar 

  52. Medeiros LJ, Greiner TC, Jaffee ES. Hodgkin’s disease. Cancer. 1995;75:357–69.

    Article  PubMed  CAS  Google Scholar 

  53. van Besien K, Kelta M, Bahaguna P. Primary mediastinal B-cell lymphoma: a review of pathology and management. J Clin Oncol. 2001;19:1855–64.

    PubMed  Google Scholar 

  54. Takeda S, Miyoshi S, Minami M, Matusda H. Intrathoracic neurogenic tumors – a 50 years experience in a Japanese institution. Eur J Cardiothorac Surg. 2004;26:807–12.

    PubMed  Google Scholar 

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Wright, C.D. (2011). Surgery for Mediastinal Disease in the Elderly. In: Katlic, M. (eds) Cardiothoracic Surgery in the Elderly. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0892-6_47

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  • DOI: https://doi.org/10.1007/978-1-4419-0892-6_47

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