Surgical treatment for giant solid tumors of the mediastinum: a study of 26 cases

Twenty-six patients with giant solid tumors of the mediastinum (GSTM) were treated surgically from 1975 to 2000. Femorofemoral cardiopulmonary bypass (CPB) was used before induction of anesthesia as a precaution against total tracheal occlusion in two cases. Resection of the tumor was accomplished in all patients, combined with partial pericardium resection in five cases, left upper lobe of lung resection in two cases, and reconstruction of the superior vena cava (SVC) and innominate vein in four cases. The weights of resected tumors ranged from 1.1 to 4.8 kg, with an average of 2.2 kg. The majority were benign (22 of 26, 84.6%). The postoperative complications included two cases with recurrent laryngeal nerve injury, three cases with wound infection, and two cases with dilatant pneumonedema. Diagnosis of GSTM was not difficult based on imaging and needle biopsy. Femorofemoral CPB is recommended before induction of anesthesia for patients with superior airway obstruction and superior vena cava occlusion. Perioperative management includes strict hemostasis, proper chest wall reconstruction, and prevention of re-expansion pulmonary edema.