Pulmonary metastasectomy in pediatric patients

Abstract

BackgroundThis study aims to evaluate the outcomes of pulmonary metastasectomy resections in pediatric patients.MethodsWe retrospectively reviewed the medical records of 43 children who were operated on in the Pediatric Surgery Clinic between January 1988 and 2014. Forty-three children (26 boys; 17 girls; mean age 10 ± 4.24 years, range 6 months–18 years) who underwent pulmonary metastasectomy resection were included in the study. The patients were evaluated based on age, gender, history of disease, surgical procedures, complications, duration of hospitalization, duration of chest tube placement, and procedure outcome.ResultsIndications for pediatric resections were oncological. Metastasis was secondary to Wilms’ tumor in 14 patients, osteosarcoma in 7 patients, Ewing’s sarcoma in 5 patients, rhabdomyosarcoma in 5 patients, lymphoma in 3 patients, hepatoblastoma in 2 patients, and other tumors in 7 patients. A total of 59 thoracotomies were performed. Approaches utilized included unilateral posterolateral thoracotomy (n = 33), bilateral posterolateral thoracotomy (n = 8), and sternotomy (n = 2). Wedge resection was the procedure of choice (n = 44). In selected cases, 11 segmentectomies, 3 lobectomies, and 1 pneumonectomy were performed. There was no perioperative mortality. One patient suffered prolonged air leak and three patients from fever. All patients received chemotherapy. Radiotherapy was administered to 16 patients (37.2 %). Of those 16 patients, 7 had Wilms’ tumor, 6 had Ewing’s sarcoma/PNET, and 3 were rhabdomyosarcoma patients. During a median follow-up of 3 years, the overall survival was 74.4 %.ConclusionsMultidisciplinary treatment involving pediatric oncologists, surgeons, and radiation oncologists is necessary to obtain positive results in children who have pulmonary metastases of oncological diseases. Wedge resection is a suitable option for children because less lung tissue is resected.

Use of bronchial blockers for thoracic surgery in pediatric oncology

“…Совершенствуются протоколы полихимиотерапии, лучевой терапии, хирургическое оборудование и техника выполнения операций. Значительный прогресс в области лечения первичных и вторичных новообразований грудной клетки, легких и средостения достигнут благодаря развитию малоинвазивной хирургии [1][2][3]. Операции из торакоскопического доступа у детей проводятся по поводу биопсий и удаления новообразований средостения (лимфомы, нейробластомы).…”

“…Операции из торакоскопического доступа у детей проводятся по поводу биопсий и удаления новообразований средостения (лимфомы, нейробластомы). В то же время торакотомный доступ остается стандартом при выполнении операций по поводу удаления метастазов ряда злокачественных опухолей, таких как остеогенная саркома и саркома Юинга [1]. Исследования показывают, что полное удаление метастазов в легких является обязательным для безрецидивного выживания пациентов [2,3].…”

Combined treatment for single giant pulmonary metastasis from osteosarcoma: from inside to outside

“…8,9 On the other hand, the patient had some favourable prognostic factors that indicated surgery, such as a disease-free interval >36 months, single pulmonary metastasis in the absence of other metastatic sites and dimension >10 cm, which is not an absolute contraindication. This is a very aggressive treatment for osteosarcoma of lung metastasis, and only few papers present similar cases treated with pneumonectomy, which is justified by the improvement in survival.…”

“…This is a very aggressive treatment for osteosarcoma of lung metastasis, and only few papers present similar cases treated with pneumonectomy, which is justified by the improvement in survival. 8,9 On the other hand, the patient had some favourable prognostic factors that indicated surgery, such as a disease-free interval >36 months, single pulmonary metastasis in the absence of other metastatic sites and dimension >10 cm, which is not an absolute contraindication. 10 It is also important to underline the location of the metastasis, with the involvement and the partial occlusion of the trachea, so by treating the metastasis radically it was possible to avoid respiratory distress and acute tracheal obstruction.…”

Radiological nodule behavior: A critical parameter in the surgical management of pediatric pulmonary metastases

“…Several factors such as size, localization and number of the metastatic nodules were investigated in previous studies to demonstrate their effects on prognosis and survival. [3][4][5][6][7] The characteristics of radiological nodule appearance, such as size or calcification on computerized tomography (CT) scan was investigated to distinguish the nature of the the nodule as malignant or benign. 8 Radiological nodule behavior (RNB) means the course of the nodule appearance on consecutive CT scans before and after chemotherapy.…”