Background. Huge mediastinal teratomas (MT) occupying more than two compartments of the mediastinum and encroaching in the pleural spaces often pose a significant challenge in the surgical treatment.
Aims. To present our experience and to draw attention to the main problems in this field.
Methods. A review was performed of 17 patients with huge MT. The age was 15 to 57 years. Male/female ratio 11/6. In 5 cases exploratory thoracotomies were earlier undertaken in other hospitals. The main reason for inability to perform the removal was severe bleeding during the tumor dissection. In 1 patient the tumor was recurrent after incomplete resection. Previous biopsies showed mature MT in all cases. We performed median sternotomy in all patients.
Results. In 15 patients the tumor was removed completely. Resection of the pericardium was necessary in 9 cases. Lobectomy or wedge lung resections were performed in 7 cases. In 1 patient the operation was palliative because of vena cava and atrium invasion, and in 1 patient was exploration only. Biopsy revealed malignant transformation in these 2 patients. The blood loss was from 425 to 2530 ml (average = 690 ml) mainly from enormously vascularised adhesions between the tumor and the chest wall. One postoperative complication - bleeding occurred in the patient after exploration with lethal outcome. Twelve patients are free of disease. Two patients where malignancy was found in removed tumor died from tumor recurrence despite irradiation and chemotherapy.
Conclusions. Surgical treatment of mature MT results in good outcome. Median sternotomy provides optimal approach to the tumor origin, for great vessels and heart protection and control bleeding during the tumor dissection from the chest wall and lungs.