“Trap-door” and “clamshell” surgical approaches for the management of pediatric tumors of the cervicothoracic junction and mediastinum

Abstract

Background/Purpose For pediatric tumors of the cervicothoracic junction, an isolated cervical or thoracic surgical approach provides insufficient exposure for achieving complete resection. We retrospectively examined “trap-door” and “clamshell” pediatric thoracotomies as a surgical approach to these tumors. Methods We searched our database for pediatric patients with cervicothoracic tumors who underwent clamshell or trapdoor thoracotomy between 1991 and 2013, reviewing tumor characteristics, surgical technique, completeness of resection, morbidity, and outcome. Results Trap-door (n=13) and clamshell (n=4) thoracotomies were performed for neuroblastoma (n=9), non-rhabdomyosarcoma soft tissue sarcoma (n=4), germ cell tumor (n=2), rhabdomyosarcoma (n=1), and neuroendocrine small cell carcinoma (n=1). Fourteen of these cervicothoracic tumors were primary, and three were metastatic. Gross total resection was achieved in 15 patients (94%). Operative complications included vocal cord paralysis (n=2), mild upper-extremity neuropraxia (n=2), and hemidiaphragm paralysis (n=1), All but one involved encased nerves. Overall survival was 61% for the series and 80% for patients with primary tumors. Eleven (73%) of 15 patients who underwent gross total resection had no evidence of recurrence. Tree patients with metastatic disease died of distant progression within 1.3 years. Conclusions Gross total resection of primary cervicothoracic tumors can be accomplished with specialized exposure in pediatric patients with minimal morbidity.

Long‐term results of the transmanubrial osteomuscular‐sparing approach for pediatric tumors

“…Use of the trap‐door approach has been described in the context of benign (cystic hygroma, mesenchymal hamartoma) or malignant (ganglioneuroma or neuroblastoma, desmoid tumor, mixoid liposarcoma, Castleman's disease, rhabdomyosarcoma, germ cell tumor, nonrhabdomyosarcoma soft tissue sarcoma and neuroendocrine small cell carcinoma) tumors, or to treat recurrent trachea‐esophageal fistula following esophageal atresia repair . The most important series involving this approach included 13 patients, who achieved an overall survival rate of 61%, which reached 80% for primary tumors . A gross total or near gross total resection was achieved in 94% of cases.…”

Effect of video‑assisted thoracoscopic surgery on pain stress indicators NO, IL‑1β and IL‑6 in the treatment of mediastinal tumor in children

“…Because pediatric mediastinal tumor is not common in clinical practice, existing studies mainly focus on the comparison of the clinical efficacy of different treatment for mediastinal tumors. For example, Fuchs et al (18) proposed that the laparoscopic minimally invasive surgery has a good clinical effect in the treatment of mediastinal tumors, and Christison-Lagay et al (19) compared the effects of different openings on pediatric mediastinal tumors. The significance of the clinical indicators of postoperative pediatric medial tumors is relatively rare.…”

Alveolar rhabdomyosarcoma of the anterior mediastinum with vessel invasion in a 4-month-old boy: a case report

“…In order to balance completeness of resection with debilitating postoperative morbidity, comprehensive preoperative planning, adequate surgical exposure and meticulous dissection are often required for favorable outcomes. To date, experiences with resection of childhood mediastinal tumors have been limited to case series and reports [ 1 , 3 , 5 ].…”

“…Nonetheless, preoperative radiology may not always identify important vascular invasion. In a case series published recently by Christison-Lagay et al ., a case of tumor invasion into pulmonary artery was not identified until open surgery, ultimately resulting in aborted surgery [ 5 ]. In our case, preoperative CT also did not show conclusive evidence of tumor invasion into the great vessels, and in view of the considerable tumor shrinkage post neoadjuvant chemotherapy, resection surgery was hence performed for our patient.…”

“…To date, the largest series concerning childhood mediastinal tumors was published in 2014 by Christison-Lagay et al . from the Sloan-Kettering Cancer Center in New York [ 5 ]. They performed “trap-door” and “clam shell” approaches to resection of various extensive cervicothoracic tumors, mostly neuroblastomas, in 17 children with age ranging from 9 month to 29.6 years.…”