Right diaphragm metastasis of endometrial cancer: a case report

A diaphragmatic tumor is usually caused by metastasis from lung cancer, malignant mesothelioma, and malignant thymoma. Endometrial cancer is rarely involved in metastasis to the diaphragm. A right anterior mediastinal tumor was found in a 60-year-old woman who was initially diagnosed with endometrial carcinoma. There was initially no relationship between the right anterior mediastinal tumor and endometrial carcinoma. Radical curative surgery was performed for endometrial carcinoma. The endometrial carcinoma stage was IA. The patient was admitted to the Department of Thoracic Surgery 6 months after the curative surgery. Intraoperative exploration showed a tumor growing in the right diaphragm. Right diaphragmotomy was performed. Immunohistochemistry showed metastasis of endometrial carcinoma to the diaphragm. Endometrial cancer solitary metastasis to the diaphragm is rare. Clinicians should be aware of this possibility. Surgical treatment followed by a pathological examination is the most useful method for determining the diagnosis of a diaphragmatic tumor due to metastasis of endometrial cancer.

Specific airway management for SVC replacement during giant anterior mediastinal tumor resection

Background Giant anterior mediastinal tumor (GAMT) resection is a challenging procedure, for which anesthesiologist might take to need special precautions. Case presentation A 48-year-old male patient had been scheduled to undergo GAMT resection and superior vena cava (SVC) replacement. The tumor spread surrounding SVC and left main bronchus (LMB), resulting in small volume of his left lung. A soft left-sided double lumen tube (DLT) was selected to keep the patency of LMB during left one lung ventilation (OLV) against the tumor weight. Semi-awake intubation with spontaneous breathing was selected for DLT insertion to avoid lower airway occlusion. During left OLV after right open thoracotomy, his SPO2 decreased below to 90%. We performed selective right upper lobe bronchial blockade using the combination of DLT and bronchial blocker. The surgery was successfully completed with this strategy. Conclusions Although such cases are rare, they are informative for anesthesiologists, providing optional strategies.

Non-Intubated Anesthesia Video-Assisted Thoracic Surgery for Subxiphoid Anterior Mediastinal Tumor Resection

Objective Subxiphoid approach for mediastinal tumor resection was reported to provide a better view and less postoperative pain. Non-intubated video-assisted thoracic surgery (NI-VATS) without muscle relaxant would decrease the possibility of postoperative airway collapse for anterior mediastinal mass operation. Herein, we sought to describe the use of NI-VATS through subxiphoid approach for anterior mediastinal tumor resection. Methods Patients that underwent subxiphoid VATS resection for anterior mediastinal tumor between December 2015 and September 2019 were retrospectively included for analysis. Patients were divided into two groups according to airway management: NI-VATS and intubated VATS (I-VATS). Intraoperative and postoperative variables were compared. Results A total of 40 patients were included. Among them, 21 patients received NI-VATS (52.5%) and 19 were treated with I-VATS (47.5%). In total, intraoperative (4/21 vs. 2/19; p = 0.446) and postoperative complications (5/21 vs. 7/19; p = 0.369) were similar between NI-VATS and I-VATS group. The anesthesia time (231.76 vs 244.71 min; p = 0.218), the operation time (152.35 vs 143.64 min; p = 0.980) and the length of stay (9.47 vs 10.57 day; p = 0.970) were similar between the two groups. Chest tube duration was shorter in NI-VATS groups (1.81 vs 1.84 day; p = 0.008), however, the total volume (351.95 vs 348.00 ml; p = 0.223) was similar. The post-operative pain scores (2.79 vs 2.93, P = 0.413) were comparable between two groups. Conclusions NI-VATS for mediastinal tumor resection via subxiphoid approach is a safe and technically feasible option. This technique leads to comparable perioperative clinical outcomes when compared with I-VATS via subxiphoid approach.