A retrospective observational study over surgical management of giant thoracic tumours: horrendous but manageable

Abstract
Background
Giant thoracic tumour (GTT) does not have a clear definition, but, as per usual terminology, they are thoracic masses whose long axis is > 10 cm or covering more than 50% of the hemithorax. The mediastinum is a unique space in the thoracic cavity that can have a wide range of masses of different cellular origins imposing both diagnostic and therapeutic challenges. This retrospective observational study aims to evaluate the surgical treatment outcomes of giant intrathoracic tumours and final histopathological diagnosis with evidence for manageability. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines has been followed for reporting this observational study.

Results
Between January 2018 and December 2022, the medical data of a total of 11 patients (06 males, 05 females; age range, 05 to 52 years) who underwent radical surgery for GTT in our centre were retrospectively reviewed in this observational study. We evaluated presenting symptoms, radiological findings, presumptive pathological diagnosis, and surgically excised mass gross and histopathological examination. Six (54.5%) of our patients were male, and five (45.5%) were female. The age range was between 05 and 52 years. The tumour localisations of our patients were five (45.5%) hemithorax and six (54.5%) mediastinal. The largest excised mass was 26 × 24 × 12 cm, and the heaviest mass was 3600 g. All patients underwent conventional open surgery. The overall survival was 100%, with no immediate postoperative mortality, indicating an excellent prognosis despite a dreadful appearance.

Conclusion
Due to neighbouring vascular structures, the surgical resection of manoeuvres in this crucial cavity with the excision of giant masses may be difficult and tricky. Preoperative diagnostic investigations and planning play a significant role in accurately localising the mass and the invasion possibility of adjacent vital structures. The results of this study may provide scientific evidence to guide the treatment of giant thoracic tumours in clinical practice.