Surgical treatment of dermoid cysts of the mediastinum

Introduction. A dermoid cyst of the mediastinum is a rare benign tumor that develops from embryonic tissues as a result of dysembryogenesis.Aim. To present the experience of surgical treatment of mediastinal dermoid cysts.Materials and methods. A retrospective analysis of the treatment of 16 patients after removal of a mediastinal dermoid cyst was performed. Gender and age, clinical symptoms, tumor size and location, surgical approach and duration of surgery, volume of blood loss, pain syndrome, duration of drainage and hospitalization, postoperative complications according to the Clavien–Dindo classification were assessed.Results. The study included 6 (37.5 %) men and 10 (62.5 %) women aged 11 months to 61 years (average age 33.2 years).Among the patients, 62.5 % were asymptomatic, the rest complained of shortness of breath, cough, discomfort and retrosternal pain. The tumor size ranged from 4.5 to 18.2 cm. The tumor was detected in the anterior-superior zone of the mediastinum in 13 (81.25 %) cases, in the posteroinferior zone – in 3 (18.75 %). Open access was used in 7 (43.75 %) cases, thoracoscopic – in 8 (50 %). In 1 case, conversion to sternotomy was performed. The lung was resected in 3 patients, the thymus gland – in 6, the left brachiocephalic vein and pericardium in 1 case each, of which 5 were resected using the thoracoscopic approach. During thoracoscopy, the volume of blood loss (12.5 (5; 65) and 100 (60; 125) ml, respectively) and the duration of surgery (72.5 (45; 155) and 141.5 (105; 154) min, respectively) were significantly lower than with open access.Pleural drainage was removed on days 1–3 after surgery. Quantitative indicators are presented as a median (25th percentile; 75th percentile). After open approaches, pain was 4–6 points on the visual analogue scale, decreasing to 2–3 points by the end of hospitalization, after thoracoscopic ones – no more than 4 points and stopped after drainage removal. Postoperative complications of I–II degree were in 3 (18.75 %) patients after open operations. Hospitalization after thoracoscopy was significantly shorter and amounted to 5.5 (5; 6.5) bed-days, with open ones – 12 (7.5; 14). There were no fatal cases. No tumor recurrences were noted in the late period.Conclusion. The absence of specific diagnostic criteria and the presence of contraindications for transthoracic puncture biopsy of the mediastinal dermoid cyst prevent preoperative verification. The surgical method is the only effective option with a favorable prognosis. and thoracoscopic intervention reduces blood loss and hospitalization time.