WHERE CHEMOTHERAPY ENDS, SURGERY BEGINS: CURATIVE RESECTION OF RESIDUAL MEDIASTINAL NSGCT : TECHNICAL NUANCES AND OPERATIVE PRINCIPLES hema.siri3@gmail.com

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WHERE CHEMOTHERAPY ENDS, SURGERY BEGINS: CURATIVE RESECTION OF RESIDUAL MEDIASTINAL NSGCT : TECHNICAL NUANCES AND OPERATIVE PRINCIPLES

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India

Video

Primary mediastinal non-seminomatous germ cell tumors (NSGCTs) are uncommon yet biologically aggressive malignancies. Despite chemosensitivity, complete surgical resection of post-chemotherapy residual disease is imperative for cure. The mediastinum, with its confined anatomy and proximity to vital structures, poses a formidable challenge for even experienced surgeons.

To showcase a high-stakes, anatomically demanding resection of residual mediastinal NSGCT post-VIP chemotherapy, performed with oncologic precision and technical finesse in a young male patient. Methods: A 20-year-old presented with a bulky anterior mediastinal mass and elevated tumor markers. Following four cycles of VIP chemotherapy and biochemical normalization, imaging revealed a 9.8 cm residual mass encasing the right brachiocephalic vein and abutting the superior vena cava and right atrium. The surgery was performed via midline sternotomy with single-lung ventilation. The video captures the meticulous dissection of vascular and cardiac interfaces, tumor mobilization, and strategic vessel preservation.

An R0 resection was accomplished without vascular reconstruction or cardiopulmonary bypass. Histology revealed post chemotherapy fibrosis with no viable malignancy. Postoperative recovery was smooth, and the patient remains recurrence-free at 6 months.

Surgical excision of post-chemotherapy residual mediastinal NSGCT is both feasible and essential for cure. This video underscores critical anatomical landmarks, challenges in vascular dissection, and reinforces the need for multidisciplinary coordination in managing these rare tumors.

https://vimeo.com/1105226825/e02e372111?share=copy