Comparative Study of Surgical Approaches for Mediastinal Masses

Background : Treatment of mediastinal masses poses a significant challenge in modern thoracic surgery. Video-assisted thoracic surgery (VATS) is gaining popularity due to its minimally invasive approach compared with traditional methods, such as thoracotomy and sternotomy. Objective : To study differences in intraoperative and perioperative periods among patients who underwent VATS, thoracotomy, or sternotomy. Material and methods : The study included a total of 616 patients with mediastinal masses who underwent surgery at the Republican Specialized Scientific Practical Medical Center of Surgery named after Academician V. Vakhidov (Tashkent, Uzbekistan): thoracotomy (n=420), sternotomy (n=84), and VATS (n=112). Propensity score matching was used for comparison to ensure balanced distribution across key preoperative characteristics. Results . In the VATS group, surgery duration was significantly shorter (83.2±17.5 minutes) compared with thoracotomy (125.7±61.9 minutes, P <.001) and sternotomy (128.8±46.1 minutes, P <.001). Intraoperative blood loss was also lower in the VATS group (125.8±7.4 mL) compared with thoracotomy (350.4±11.4 mL, P <.001) and sternotomy (400.6±13.5 mL, P <.001). The mean duration of mechanical ventilation was 2.49±0.5 hours in the VATS group, which was significantly shorter than in the thoracotomy group (8.3±2.1 hours, P <.001) and the sternotomy group (10.1±3.3 hours, P <.001). Postoperative hospital stay was shorter in the VATS group (7.4±2.7 days) compared with thoracotomy (11.5±4.1 days) and sternotomy (11.7±4.3 days, P <.001). The rate of early postoperative complications was also significantly lower in the VATS group with 2 cases (2.6%) compared with 12 cases (15.6%) in the thoracotomy group and 14 cases (18.2%) in the sternotomy group ( P =.006 and P =.002, respectively). Conclusions : VATS demonstrated advantages over traditional methods, such asthoracotomy and sternotomy. It offers shorter surgery duration and hospital stay, decreased blood loss, and fewer complications.