Surgical Management of Primary and Metastatic Cardiac Malignancies: A 20-Year Single-Center Experience

Figures

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  Fig. 1. Surgical findings of malignant pericardial mesothelioma. (Patient No. 1) Contrast-enhanced CT demonstrated multiple nodular lesions along the pericardium, suggesting malignant pericardial mesothelioma (panel A, arrows). The operation was performed with the patient in the right lateral decubitus position. Through the left fourth intercostal space, the pleura was opened to enter the thoracic cavity. The largest tumor, measuring approximately 5 cm, was excised en bloc with the pericardium (panel B). The pericardial defect was enlarged to create a pericardial window. The resected specimen is shown in panel (C). CT, computed tomography

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  Fig. 2. Surgical findings of invasive thymic carcinoma. (Patient No. 2) Contrast-enhanced computed tomography revealed an anterior mediastinal mass and poor opacification of the SVC, which indicated thrombus or bland thrombus (panel A, arrows). Intraoperative findings are shown in panel B. Median sternotomy was performed, and the anterior mediastinal tumor was carefully dissected. Cardiopulmonary bypass was established via the right femoral artery and right atrium. The tumor within the SVC was completely adherent along its full length (left image; arrow indicates the tumor). The SVC was divided proximally (right image; arrow indicates the SVC). The tumor was resected en bloc (panel C). The right phrenic nerve was involved. Reconstruction of the SVC was performed using a PTFE graft. SVC, superior vena cava; PTFE, polytetrafluoroethylene

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  Fig. 3. Surgical finding of metastatic adenocarcinoma. (Patient No. 15) Preoperative contrast-enhanced magnetic resonance imaging showed a large mass occupying the right atrium (panel A, arrows). Intraoperative findings are shown in panel B. Through a right fourth intercostal thoracotomy, the tumor extensively and firmly infiltrated the right atrial wall, extending to the roof of the left atrium. Cardiopulmonary bypass was established via the right femoral artery and vein. The right atrial wall was resected en bloc. A firm, white tumor measuring 55 × 38 mm was completely excised (panel C).

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  Fig. 4. Overall survival for the entire cohort. Kaplan–Meier curve showing overall survival for all 16 patients who underwent a surgical procedure for malignant cardiac tumors. The median overall survival was 11 months (95% CI, 2–39 months). CI, confidence interval

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  Fig. 5. Kaplan–Meier curve comparing overall survival between patients with primary cardiac malignancies (n = 7) and those with metastatic cardiac tumors (n = 8).

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  Fig. 6. Kaplan–Meier curve comparing overall survival among patients with complete (R0), microscopic residual (R1), and macroscopic residual (R2) resection.

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  Fig. 7. Kaplan–Meier curve comparing overall survival between different histology (angiosarcoma vs. others). The median overall survival of angiosarcoma patients was 5 months (range, 1–39 months).