Has there been a paradigm shift in mediastinal surgery from open to minimally invasive, and from magnetic resonance imaging (MRI) to positron emission tomography-computerized tomography (PET-CT) in the last decade?

Abstract

The purpose of this study was to investigate the effects of diagnostic and surgical developments in the complete resection of the mediastinal masses. Of 313 patients, 236 underwent therapeutic or diagnostic complete resections. We analyzed age, gender, diagnostic interventions, neoadjuvant treatment, type of surgical intervention (sternotomy, video-assisted thoracic surgery [VATS], thoracotomy), pathology, duration of hospital stay, complications, mortality, and associated diseases. Patients were divided into two groups according to the period of operation: group A included patients who were operated on between January 2002 and January 2007; group B included patients who were operated on between January 2007 and January 2012. Resection with VATS increased significantly after 2007, from 17.7 to 35 % (p = 0.03). The rate of complications increased after 2007 (p = 0.03), which was apparent in non-VATS patients (p = 0.03). The use of magnetic resonance imaging (MRI) decreased from 29 to 15.5 % (p = 0.02) and positron emission tomography (PET)-computed tomography (CT) use increased from 1.6 to 25.2 % (p < 0.001). We identified a paradigm shift in mediastinal mass surgery. PET-CT became a more preferred diagnostic method and MRI became less preferred. The rate of VATS resection doubled and sternotomy decreased. Complication rates increased in non-VATS due to an increase in extended resections.