Mediastinal Tumor Resection

Pronunciation: Mee-dee-a-STYE-nul
by Diana Kohnle

Definition

This is surgery to remove tumors in the area of the chest cavity that separates the lungs.

Regions of the Lung

BQ00042_97870_1_Regions_Lung
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Reasons for Procedure

Malignant (cancerous) tumors must be removed to prevent the spread of cancer. Without removal or treatment, the cancer could spread to other areas of the body. The cancer could also start to compress organs in the chest, such as the heart, lungs, or esophagus.

Patients who undergo this surgery often have a better prognosis than those who receive either radiation or chemotherapy.

Possible Complications    TOP

Complications are rare, but no procedure is completely free of risk. If you are planning to have mediastinal tumor resection, your doctor will review a list of possible complications, which may include:

  • Damage to the areas surrounding the tumor, including the heart, lungs, and spinal cord
  • Fluid collecting between the lung tissue lining and the wall of the chest cavity
  • Drainage, infection, or bleeding

Factors that may increase the risk of complications include:

What to Expect    TOP

Prior to Procedure

Before the surgery, your doctor may do the following:

  • Physical exam
  • Blood tests
  • X-ray —a test that uses radiation to take a picture of structures inside the body
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
  • CT scan —a type of x-ray that uses a computer to make pictures of the inside of the body
  • PET scan —a test that uses radiation to show activity in body tissue

Leading up to the surgery:

  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin)
    • Blood thinners (eg, clopidogrel [Plavix])
    • Anti-platelet drugs (eg, warfarin [Coumadin])
  • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.
  • Arrange for someone to drive you home from the hospital. Also, arrange for help at home.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

Description of the Procedure

You will have a breathing tube and be given an IV. The IV will be used to give you medicines and fluids during the surgery.

To remove the tumor, the doctor will either make one large, central incision in the chest or several small incisions. If several small incisions are made, a camera will be inserted into one incision. The camera will allow the doctor to view the area via monitor. Through the other incisions, surgical tools will be inserted.

The doctor may insert tubes in your chest. These tubes will help to drain fluid and air from the chest cavity. The incisions will be closed with staples or stitches.

Immediately After Procedure

The breathing tube will be removed. You will be monitored closely for any complications from the procedure.

How Long Will It Take?

About 1-4 hours (depending on the type of surgery)

How Much Will It Hurt?

The anesthesia will ease discomfort after surgery. It is common for the surgical area to be tender. Your doctor will give you pain medicine.

Average Hospital Stay

This surgery is done in a hospital setting. The usual length of stay is four days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

After surgery, you may need chemotherapy and/or radiation therapy.

In the hospital, you will be given a clear liquid diet. You will be instructed to practice deep breathing and coughing to help your lungs recover.

Once you are home, be sure to follow your doctor's instructions, including:

  • Avoid lifting objects heavier than five pounds.
  • Do not to drive for 4-6 weeks.
  • Increase your activity as you are able. This will help you recover.

Ask your doctor about when it is safe to shower, bathe, or soak in water.

Call Your Doctor    TOP

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Pain that you cannot control with the medicines you have been given
  • Cough, difficulty breathing, or chest pain
  • Pain, burning, urgency, or frequency of urination, or persistent bleeding in the urine
  • Persistent nausea and/or vomiting
  • Loss of appetite
  • Pain and/or swelling in your feet, calves, or legs
  • Any other worrisome symptoms

In case of an emergency, call for medical help right away.

RESOURCES:

American Cancer Society
http://www.cancer.org/docroot/home/index.asp
National Cancer Institute
http://www.cancer.gov/

CANADIAN RESOURCES:

BC Cancer Agency
http://www.bccancer.bc.ca/default.htm
Canadian Cancer Society
http://www.cancer.ca

References:

Flores RM. Surgical management of primary mediastinal germ cell tumors. The Cardiothoracic Surgery Network website. Available at: http://www.ctsnet.... . Updated May 2005. Accessed March 1, 2007.
Khatri VP, Asensio JA. Operative Surgery Manual . Philadelphia, PA: Saunders; 2003.
Liu HP, Yim AP, Wan J, et al. Thorascopic removal of intrathoracic neurogenic tumors: a combined Chinese experience. Annals of Surgery . 2000;232:187-190.
Townsend CM, et al. Sabiston Textbook of Surgery . 17th ed. Philadelphia, PA: Saunders; 2004.
6/3/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed December 2011 by Marcin Chwistek, MD
Last Updated: 12/30/2011
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