Ricerc@Sapienza

The surgical treatment of locally advanced mediastinal tumors invading the great vessels and
other nearby structures still represent a tricky question, principally due to the technical complexity of the
resective phase, the contingent need to carry out viable vascular reconstructions and, therefore, the proper
management of pathophysiologic issues. Published large-number series providing oncologic outcomes
of patients who have undergone extended radical surgery for invasive mediastinal masses are just a few.
Furthermore, the wide variety of different histologies included in some of these studies, as well as the
heterogeneity of chemo and radiation therapies employed, did not allow for the development of clear
oncologic guidelines. Usually in the past, surgical resections of large masses along with the neighbouring
structures were not offered to patients because of related morbidity and mortality and limited information
available on the prognostic advantage for long term. However, in the last decades, advances in surgical
technique and perioperative management, as well as increased oncologic experience in this field, have allowed
radical exeresis in selected patients with invasive tumors requiring resections extended to the surrounding
structures and complex vascular reconstructions. Such aggressive surgical treatment has been proposed in
association or not with adjuvant chemo- or radiotherapy regimens, achieving encouraging oncologic results
with limited morbidity and mortality in experienced institutions. Congestive heart failure or impending
cardiovascular collapse due to the compression by the large mass are the most frequent immediately lifethreatening
problems that some of these patients can experience. In this setting, medical palliation is usually
ineffective and an aggressive salvage surgical treatment may remain the only therapeutic option.