Ann Thorac Surg 1998;66:239
© 1998 The Society of Thoracic Surgeons
Original articles: general thoracic
Invited commentary
Lawrence H. Einhorn, MDa
a Division of Hematology-Oncology, Indiana University Medical Center, 535 Barnhill Dr, Rm 473, Indianapolis, IN 46202-5289, USA
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Invited commentary
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 Invited commentary
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Bacha and colleagues reported a retrospective review of 89 patients who underwent operation for mediastinal tumor from 1979 to 1995. The cell types included thymoma (35), thymic carcinoma (12), germ cell tumors (17), lymphoma (16), and miscellaneous tumors (9). Total resection was possible in 80% of cases. This type of operation is best done at a tertiary center with the type of thoracic surgical expertise that is available at the Centre Chirurgical Marie-Lannelongue. For example, 21 patients had resection of superior vena cava.
Bacha and colleagues provide excellent details and guidelines for these complicated cases. However, I would like to stress two additional points: (1) Primary mediastinal seminoma has an excellent cure rate with cisplatin combination chemotherapy. Presentation with a large anterior mediastinal mass is almost always followed by a residual postchemotherapy mass. At our institution, we observe these patients and only intervene if the mass enlarges. In this series, 3 patients had mediastinal seminoma. What was the pathologic result and subsequent outcome for these 3 patients? (2) Eight patients with lymphoma had preoperative chemotherapy followed by resection, and 6 had only necrosis in the resection. It is probably best to reserve operation for patients with positive gallium scan or positron emission tomographic scan after primary chemotherapy.
