VATS or sternotomy in mediastinal tumours?Time for crashworthiness

Abstract

Introduction: Mediastinal surgery poses a challenge with regards to complete tumour resection, diagnostic efficacy and expedited recovery.

Aim: Comparison of different surgical approaches (VATS, sternotomy) in the management of mediastinal tumours in terms of clinical parametres, diagnostic yield, patient burden, recovery time.Materials and Methods: Retrospective review of all patient records and thoracic surgery databases relating to surgical procedures for the management of mediastinal tumours during 2006-2020. The following parameters have been comparatively studied for each method: mortality, diagnostic yield, patient burden, post operative pain, recovery time.

Results: During 2006-2020, 61 patients underwent mediastinal tumour surgery (59% men, mean age 62,4 years. Pathology diagnosed in the majority thymomas (20/61) and granulomas 17/61. 23/61 patients had VATS and the remaining sternotomy. Correlation between type of surgery and recovery time was statistically significant (p<0.05) with VATS ensuring return to daily activities in mean 7 days versus 13 days for hemisternotomy. VATS patients reported mean 3/10 post-operative pain and overall burden (Likert scale) at 24hours post surgery versus 8/ 10 for sternotomy. Mortality was 0%. Duration of procedure was 3 hours for the hemi-sternotomy and 3,75  VATS (p>0.05).

Conclusions: VATS is less painful postoperatively enhancing a faster recovery, though the operation lasts longer. Postoperative pain, patient burden and recovery time are considerably less in VATS patients. VATS secures an overall better outcome on the note of appropriate patient selection and surgeon’s competency in minimal invasive surgery and conventional surgery should the need arise.