The Annals of Thoracic Surgery, Vol 44, 363-369, Copyright © 1987 by The Society of Thoracic Surgeons
Surgical management of lymphomas involving the chest
A Yellin, HY Pak, JS Burke and JR Benfield
Division of Surgery, City of Hope National Medical Center, Duarte, CA.
The efficacy of surgical judgments in the management of thoracic lymphoma
was studied through review of 34 patients with primary mediastinal
lymphomas, 30 patients who needed one or more thoracic operations after
treatment of extrathoracic lymphomas, and 5 patients with primary
lymphocytic infiltrates (PLI) of the lung. In all patients with primary
lymphocytic infiltrates of the lung, thoracotomies were required in order
to establish the correct diagnosis. Patients with primary mediastinal
lymphoma required 74 surgical procedures (2.2 per patient) to establish the
correct diagnosis. In retrospect, 40 operations were not beneficial. The
procedures that provided diagnostic samples were 15 anterior
mediastinotomies, 8 full thoracotomies, 3 median sternotomies, and 8 lesser
procedures such as mediastinoscopy. Patients who needed thoracic procedures
after treatment of extrathoracic lymphomas had 41 thoracic operations (1.37
per patient). Five operations were needed to manage complications of
thoracic lymphoma or its therapy. To evaluate new radiographic findings,
there were 35 operations (1.3 per patient) at a mean interval of 5.0 years
following initial treatment; the findings were recurrent lymphoma in 62%
and new lesions in 38% of patients. Among new lesions, there were 2
bronchogenic cancers; 9 enlarging mediastinal-pleural masses were not
caused by lymphoma. The accurate diagnosis of thoracic lymphoma or new
thoracic lesions in patients with lymphomas usually requires enough tissue
for immunophenotyping. Providing adequate tissue samples and treating new
lesions that are not lymphomas often require major thoracomediastinotomies
for immunophenotyping.
