Surgical considerations in the resection of solitary fibrous tumors of the pleura
Abstract Solitary fibrous tumors (SFTs) are rare mesenchymal pleural neoplasms with an overall good prognosis and low recurrence rate if completely resected and if degree of differentiation is favorable. Within the last decade, advances in research have led to more reliable methods of differentiatin...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-02-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-023-02168-7 |
| _version_ | 1827982871978049536 |
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| author | Hana Ajouz Amir Humza Sohail Hassan Hashmi Myriam Martinez Aguilar Sabrina Daoui Miltiadis Tembelis Muhammad Aziz Tirajeh Zohourian Collin E. M. Brathwaite Robert J. Cerfolio |
| author_facet | Hana Ajouz Amir Humza Sohail Hassan Hashmi Myriam Martinez Aguilar Sabrina Daoui Miltiadis Tembelis Muhammad Aziz Tirajeh Zohourian Collin E. M. Brathwaite Robert J. Cerfolio |
| author_sort | Hana Ajouz |
| collection | DOAJ |
| description | Abstract Solitary fibrous tumors (SFTs) are rare mesenchymal pleural neoplasms with an overall good prognosis and low recurrence rate if completely resected and if degree of differentiation is favorable. Within the last decade, advances in research have led to more reliable methods of differentiating SFTs from other soft tissue tumors. Historically, several markers were used to distinguish SFTs from similar tumors, but these markers had poor specificity. Recent evidence showed NAB2-STAT6 fusion gene to be a distinct feature of SFTs with 100% specificity and sensitivity. Surgical resection, with an emphasis on obtaining negative margins, is the mainstay of treatment for SFTs. Preoperative planning with detailed imaging is imperative to delineate the extent of disease and vascular supply. One important radiologic distinction to aid delineation of a pleural-based tumor compared to a pulmonary parenchymal-based tumor is the angle that the tumor forms with the chest wall, which is obtuse for a pleural-based tumor, and acute for tumors of the lung parenchyma. Often, preoperative tissue diagnosis is not available, and surgery is both diagnostic and curative. Intraoperatively, emphasis should be on complete resection with negative margins. SFTs are resected via several approaches: thoracotomy, sternotomy with the option of hemi-clamshell extension, video-assisted thoracoscopic surgery, and robotic approach, which is increasingly being used and is our preference. We recommend a minimally invasive approach for most lesions, and have resected SFTs of the pleura that are up to 12 cm with the robotic approach. However, the current literature often cites 5 cm as the cut off for an open thoracotomy. Nevertheless, even with larger tumors, a minimally invasive robotic approach is our preference and practice. For giant SFTs (> 20 cm), an open approach may be preferable. Multiple thoracotomies and rib resection may be required to gain adequate exposure and ensure complete resection in these tumors. However, it is noteworthy that most of these tumors have a soft consistency and thus, once bagged, can easily be removed minimally invasively, and thus minimally invasive approach should not be completely ruled out. Recurrence in SFTs usually results from incomplete resection and redo surgery may portend a favorable prognosis. |
| first_indexed | 2024-04-09T22:38:48Z |
| format | Article |
| id | doaj.art-f4ffd4b7d2c9448594fcec03dd1afa45 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-09T22:38:48Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-f4ffd4b7d2c9448594fcec03dd1afa452023-03-22T12:20:11ZengBMCJournal of Cardiothoracic Surgery1749-80902023-02-011811810.1186/s13019-023-02168-7Surgical considerations in the resection of solitary fibrous tumors of the pleuraHana Ajouz0Amir Humza Sohail1Hassan Hashmi2Myriam Martinez Aguilar3Sabrina Daoui4Miltiadis Tembelis5Muhammad Aziz6Tirajeh Zohourian7Collin E. M. Brathwaite8Robert J. Cerfolio9Department of Surgery, University of Miami Health SystemDepartment of Surgery, New York University Langone HealthDepartment of Surgery, LeHigh Valley Health NetworkDepartment of Surgery, Mayo ClinicNew York University Long Island School of MedicineDepartment of Radiology, New York University Langone HealthDepartment of Medicine, University of Toledo Medical CenterDepartment of Surgery, New York University Langone HealthDepartment of Surgery, New York University Langone HealthDepartment of Surgery, New York University Langone HealthAbstract Solitary fibrous tumors (SFTs) are rare mesenchymal pleural neoplasms with an overall good prognosis and low recurrence rate if completely resected and if degree of differentiation is favorable. Within the last decade, advances in research have led to more reliable methods of differentiating SFTs from other soft tissue tumors. Historically, several markers were used to distinguish SFTs from similar tumors, but these markers had poor specificity. Recent evidence showed NAB2-STAT6 fusion gene to be a distinct feature of SFTs with 100% specificity and sensitivity. Surgical resection, with an emphasis on obtaining negative margins, is the mainstay of treatment for SFTs. Preoperative planning with detailed imaging is imperative to delineate the extent of disease and vascular supply. One important radiologic distinction to aid delineation of a pleural-based tumor compared to a pulmonary parenchymal-based tumor is the angle that the tumor forms with the chest wall, which is obtuse for a pleural-based tumor, and acute for tumors of the lung parenchyma. Often, preoperative tissue diagnosis is not available, and surgery is both diagnostic and curative. Intraoperatively, emphasis should be on complete resection with negative margins. SFTs are resected via several approaches: thoracotomy, sternotomy with the option of hemi-clamshell extension, video-assisted thoracoscopic surgery, and robotic approach, which is increasingly being used and is our preference. We recommend a minimally invasive approach for most lesions, and have resected SFTs of the pleura that are up to 12 cm with the robotic approach. However, the current literature often cites 5 cm as the cut off for an open thoracotomy. Nevertheless, even with larger tumors, a minimally invasive robotic approach is our preference and practice. For giant SFTs (> 20 cm), an open approach may be preferable. Multiple thoracotomies and rib resection may be required to gain adequate exposure and ensure complete resection in these tumors. However, it is noteworthy that most of these tumors have a soft consistency and thus, once bagged, can easily be removed minimally invasively, and thus minimally invasive approach should not be completely ruled out. Recurrence in SFTs usually results from incomplete resection and redo surgery may portend a favorable prognosis.https://doi.org/10.1186/s13019-023-02168-7Lung tumorSolitary fibrous tumorSurgeryVATS |
| spellingShingle | Hana Ajouz Amir Humza Sohail Hassan Hashmi Myriam Martinez Aguilar Sabrina Daoui Miltiadis Tembelis Muhammad Aziz Tirajeh Zohourian Collin E. M. Brathwaite Robert J. Cerfolio Surgical considerations in the resection of solitary fibrous tumors of the pleura Journal of Cardiothoracic Surgery Lung tumor Solitary fibrous tumor Surgery VATS |
| title | Surgical considerations in the resection of solitary fibrous tumors of the pleura |
| title_full | Surgical considerations in the resection of solitary fibrous tumors of the pleura |
| title_fullStr | Surgical considerations in the resection of solitary fibrous tumors of the pleura |
| title_full_unstemmed | Surgical considerations in the resection of solitary fibrous tumors of the pleura |
| title_short | Surgical considerations in the resection of solitary fibrous tumors of the pleura |
| title_sort | surgical considerations in the resection of solitary fibrous tumors of the pleura |
| topic | Lung tumor Solitary fibrous tumor Surgery VATS |
| url | https://doi.org/10.1186/s13019-023-02168-7 |
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