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Surgical access to the mediastinum- all roads lead to Rome : a literature review.

Authors :
Mayer N
Kestenholz P
Minervini F
Source :
Mediastinum (Hong Kong, China) [Mediastinum] 2024 May 17; Vol. 8, pp. 28. Date of Electronic Publication: 2024 May 17 (Print Publication: 2024).
Publication Year :
2024

Abstract

Background and Objective: The mediastinum is a complex, heterogeneous area, which leads vertically across the thoracic cavity between the bilateral mediastinal pleurae, connecting the head and neck region with the thoracic cavity. Different classifications have been published to differentiate between the so-called mediastinal compartments while the most used classification surely is the 4-compartments Gray`s classification, dividing it into the superior, anterior, middle and posterior mediastinum. Mediastinal abnormalities include infections (mediastinitis) and solid or cystic mediastinal masses. These masses can be divided into benign and malignant lesions originating from mediastinal structures/organs or represent manifestations of metastatic disease, often metastatic non-small cell lung cancer (NSCLC). This review aims to explore the different mediastinal pathologies along with indications and surgical approaches.<br />Methods: We performed literature research in PubMed, MEDLINE, Embase, CENTRAL, and CINAHL databases. Only papers written in English were included.<br />Key Content and Findings: Depending on the indication for surgical intervention and the localization of the pathology, surgical approach may differ immensely. Mediastinal staging of lung cancer, primary lesions of the mediastinum, mediastinitis and traumatic mediastinal injuries display the most frequent indications for mediastinal surgery. Surgical approaches trend towards minimally invasive, video- or robotic-assisted techniques and are becoming increasingly refined to adapt to the special characteristics of the mediastinum. However, certain indications still require open access for best possible mediastinal exposure or oncological reasons.<br />Conclusions: To guide optimal surgical approach selection to the mediastinum, the following overview will present all published surgical approaches to the mediastinum and discuss their practical relevance and indications aiming to help surgeons in the management of patients with mediastinal pathologies who should undergo surgery.<br />Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-23-71/coif). The authors have no conflicts of interest to declare.<br /> (2024 Mediastinum. All rights reserved.)

Details

Language :
English
ISSN :
2522-6711
Volume :
8
Database :
MEDLINE
Journal :
Mediastinum (Hong Kong, China)
Publication Type :
Academic Journal
Accession number :
38881816
Full Text :
https://doi.org/10.21037/med-23-71