{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T08:16:55Z","timestamp":1788337015491,"version":"build-2803163510"},"reference-count":109,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Mediastinal paragangliomas (MPs) are rare, highly vascular neuroendocrine tumors whose surgical resection is the gold standard but carries a high risk of perioperative complications due to the MPs\u2019 proximity to major cardiovascular structures with potential life-threatening hemorrhage. Due to their rarity, the literature consists primarily of case reports. Our systematic review aims to synthesize the evidence from the last two decades to propose a standardized, multidisciplinary approach to the diagnosis and surgical management of MPs. Methods: A systematic literature review was conducted from 2005 to 2025. Studies reporting on surgically resected adult mediastinal paragangliomas were included. Patient demographic data, diagnostic workup, surgical approaches, and outcomes were extracted and analyzed descriptively. Results: Analysis of 79 patients from 75 papers revealed a median age of 50 years (female predominance of 62%). Most tumors were in the middle mediastinum (51.9%). Sternotomy was the most common surgical approach (44.3%), with cardiopulmonary bypass utilized in 27.8% of cases. Postoperative complications occurred in 28% of patients, with left vocal cord palsy (12.7%) being most frequent. The median follow-up was 12 months. All percentages refer to the number of patients. Conclusions: Surgical removal is the standard of care for curative treatment of MPs. However, surgical treatment requires meticulous planning within a multidisciplinary team to reduce the risk of perioperative complications. The choice of surgical approach\u2014open, minimally invasive, or with circulatory support\u2014depends on tumor site, size, and vascular involvement. This review consolidates existing evidence of MPs\u2019 surgical management, aiming to mitigate the significant risks associated with surgery. Lifelong follow-up is essential due to the potential for recurrence.<\/jats:p>","DOI":"10.3390\/cancers18030486","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T14:12:46Z","timestamp":1770041566000},"page":"486","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Surgical Approaches and Perioperative Outcomes in Mediastinal Paragangliomas: A 20-Year Comprehensive Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1325-9284","authenticated-orcid":false,"given":"Nicola","family":"Rotolo","sequence":"first","affiliation":[{"name":"Thoracic Surgery Unit, Department of Medicine and Technological Innovation, University of Insubria, Ospedale di Circolo, 21100 Varese, Italy"},{"name":"Thoracic Surgery Unit, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Cerretani","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoraco-Vascular Diseases, Fondazione IRCCS Ca\u2019 Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1206-228X","authenticated-orcid":false,"given":"Sabrina","family":"Casagrande","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Unit, ASST Settelaghi, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Nardecchia","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Ospedale ASST-Settelaghi, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1664-9460","authenticated-orcid":false,"given":"Elena","family":"Asteggiano","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Ospedale ASST-Settelaghi, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8904-7395","authenticated-orcid":false,"given":"Alberto","family":"Colombo","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Department of Medicine and Technological Innovation, University of Insubria, Ospedale di Circolo, 21100 Varese, Italy"},{"name":"Thoracic Surgery Unit, Department of Medicine and Surgery, University of Insubria, Ospedale di Circolo, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0131-9817","authenticated-orcid":false,"given":"Luca","family":"Filipponi","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Unit, Ospedale ASST-Settelaghi, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0756-9967","authenticated-orcid":false,"given":"Filippo","family":"Piacentino","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Schiorlin","family":"Ilaria","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Unit, ASST Settelaghi, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3809-5696","authenticated-orcid":false,"given":"Federico","family":"Fontana","sequence":"additional","affiliation":[{"name":"Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1016\/j.athoracsur.2008.04.105","article-title":"Mediastinal paragangliomas: The Mayo clinic experience","volume":"86","author":"Brown","year":"2008","journal-title":"Ann. 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