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Wagener M, Peer N, Sheik-Gafoor MH. The role of thoracoscopic lung biopsy in the management of children with solid organ malignancies and suspected lung metastases in a developing country. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00123-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Accurate diagnosis of lung lesions appearing on computed tomographic (CT) imaging in children with solid organ malignancies can be difficult. Therefore, this study aimed to determine, in a developing country setting, (1) the utility of thoracoscopic lung biopsy for assessment of suspected lung metastases in solid organ malignancies, and (2) the pathology of biopsied lesions suspected to be malignancies. The electronic records of all patients with solid organ malignancies who underwent thoracoscopic lung biopsies for suspected metastases at a tertiary hospital in South Africa between January 2012 and December 2017 were analysed retrospectively.
Results
A total of 29 thoracoscopic biopsies were taken from 25 patients. In eight biopsies (27.6%), viable metastatic tumour was identified; in one, a completely necrotic tumour was found. Seven patients (28.0%) were found to have infective aetiologies which required alternative therapies: of these, three patients had tuberculosis; three had bronchopneumonia and one had a fungal lung infection. Other findings included haemorrhagic infarction (n = 1); non-specific fibrosis (n = 1) and reactive lymph node (n = 1). In ten biopsies (34.5%), no lesion was found on thoracoscopy.
Conclusions
Thoracoscopy was found to improve the management of children with solid organ malignancies and suspected metastases. Thoracoscopy enabled many patients to avoid additional chemotherapy and radiotherapy and its negative consequences and enabled therapy for specific benign pathologies including infections.
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Pulmonary Metastasectomy in Pediatric Solid Tumors. CHILDREN-BASEL 2019; 6:children6010006. [PMID: 30626161 PMCID: PMC6352020 DOI: 10.3390/children6010006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 12/24/2018] [Accepted: 12/24/2018] [Indexed: 11/16/2022]
Abstract
Metastatic disease and the complications of treating metastatic disease are the primary causes of mortality in children with solid malignancies. Nearly 25% of children with solid tumors have metastatic disease at initial diagnosis and another 20% develop metastases during or after treatment. The most common location of these metastases is the lung. The role of surgery in metastatic disease depends greatly on the histology of the primary. In general, tumors that are refractory to adjuvant therapies are most appropriate for pulmonary metastasectomy. This article will summarize the indications for metastasectomy in pediatric solid tumors and discuss the ongoing debate over the technique of metastasectomy in osteosarcoma.
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Pulmonary Complications of Malignancies and Blood and Marrow Transplantation. PULMONARY COMPLICATIONS OF NON-PULMONARY PEDIATRIC DISORDERS 2018. [PMCID: PMC7120544 DOI: 10.1007/978-3-319-69620-1_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Scanagatta P, Girelli L. Metastasectomy in pediatric patients: indications, technical tips and outcomes. J Thorac Dis 2017; 9:S1299-S1304. [PMID: 29119018 DOI: 10.21037/jtd.2017.09.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary metastasectomy has become a standard procedure for pediatric patients with certain types of solid tumors. Surgeons, expert pediatric oncologists and radiation oncologists contribute with their different skills to the management of pulmonary metastases. Patients are usually scheduled for surgery in case of primary tumor control, in absence of metastases in other organs and when a complete resection is achievable. Nodules are removed through precision resections using electrocautery or laser methods in order to ensure radical surgery with adequate margins. With these techniques, it is possible to preserve the surrounding parenchyma and cause a limited volumetric distortion as compared with staplers. Anatomical resections (segmentectomy, lobectomy or pneumonectomy) should be reserved for selected cases, since major lung resection can only be justified if it leads to a real oncological advantage. Repeated thoracotomies are possible, since there is no theoretical limit to reinterventions. Surgery of lung metastases has a therapeutic and curative role for some histology with acceptable rate of complications but it finds its role only in an aggressive multimodality approach. Indications can be discussed case by case and exceptions can be evaluated also in presence of different evidences. Children affected by metastatic tumors need to be managed by expert multidisciplinary oncological team in referral center with large experience.
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Affiliation(s)
- Paolo Scanagatta
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lara Girelli
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Abstract
Most children who succumb to solid malignancies do so because of the burden of metastatic disease or due to complications associated with the therapy administered to treat metastatic disease. Approximately one-quarter of children with solid tumors will present with metastatic disease, and an additional 20% ultimately develop metastatic disease, most commonly in the lung. The role of surgery in the treatment of metastatic solid tumors, given its disseminated nature, is not intuitive, yet there are circumstances in which surgical resection of metastatic disease can potentially be curative. However, the utility of surgery is very much dependent on histology, and generally is most appropriate for those malignancies with histologies that are refractory to other adjuvant therapies.
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Affiliation(s)
- Todd E. Heaton
- Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN
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Shi Y, Geller JI, Ma IT, Chavan RS, Masand PM, Towbin AJ, Chintagumpala M, Nuchtern JG, Tiao GM, Thompson PA, Vasudevan SA. Relapsed hepatoblastoma confined to the lung is effectively treated with pulmonary metastasectomy. J Pediatr Surg 2016; 51:525-9. [PMID: 26607968 DOI: 10.1016/j.jpedsurg.2015.10.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/15/2015] [Accepted: 10/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND In children diagnosed with hepatoblastoma (HB), the lungs are the most common site of metastasis at both initial presentation and relapse. Previous studies have encouraged pulmonary metastasectomy to achieve a disease-free state after resection of the primary hepatic lesion. However, there is no consensus about how to manage recurrent pulmonary metastasis. PROCEDURE A retrospective, multi-institutional review was performed from 2005 to 2014 to identify HB patients ≤18years of age who had disease recurrence associated with pulmonary metastases alone. RESULTS Ten patients between the ages of 8 and 33months were identified. Pulmonary metastatic recurrence was detected by measuring alpha-fetoprotein (AFP) levels and/or with CT scans of the chest. All patients subsequently underwent pulmonary metastasectomy without post-operative complications. At last follow-up, 8 patients were alive and had normal AFP levels. The 8 survivors had a median follow-up from therapy completion of 18.5months. Two patients who presented with extrapulmonary recurrence subsequently died of treatment refractory disease. CONCLUSIONS This review supports surgical resection as a safe and, in the context of multimodal therapy, efficacious approach to manage HB patients who present with isolated pulmonary relapse.
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Affiliation(s)
- Yan Shi
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cancer and Blood Diseases Institute, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Irene T Ma
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona
| | - Rishikesh S Chavan
- Pediatric Hematology-Oncology, Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana
| | - Prakash M Masand
- Department of Pediatric Radiology, Texas Children's Hospital, Department of Radiology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX
| | - Alexander J Towbin
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital, Department of Radiology, University of Cincinnati, Cincinnati, Ohio
| | - Murali Chintagumpala
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Greg M Tiao
- Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Patrick A Thompson
- Division of Hematology-Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
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Erginel B, Gun Soysal F, Keskin E, Kebudi R, Celik A, Salman T. Pulmonary metastasectomy in pediatric patients. World J Surg Oncol 2016; 14:27. [PMID: 26837694 PMCID: PMC4736125 DOI: 10.1186/s12957-016-0788-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/26/2016] [Indexed: 11/23/2022] Open
Abstract
Background This study aims to evaluate the outcomes of pulmonary metastasectomy resections in pediatric patients. Methods We 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. Results Indications 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 %. Conclusions Multidisciplinary 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.
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Affiliation(s)
- Basak Erginel
- Istanbul Faculty of Medicine, Department of Pediatric Surgery, Istanbul University, Oguz Goker Caddesi, 5. Gazeteciler Sitesi, C-1 Blok No. 36, Akatlar Mahallesi, Besiktas, Istanbul, Turkey.
| | - Feryal Gun Soysal
- Istanbul Faculty of Medicine, Department of Pediatric Surgery, Istanbul University, Oguz Goker Caddesi, 5. Gazeteciler Sitesi, C-1 Blok No. 36, Akatlar Mahallesi, Besiktas, Istanbul, Turkey.,Department of Pediatric Hematology and Oncology, Istanbul University, Institute of Oncology, Istanbul, Turkey
| | - Erbug Keskin
- Istanbul Faculty of Medicine, Department of Pediatric Surgery, Istanbul University, Oguz Goker Caddesi, 5. Gazeteciler Sitesi, C-1 Blok No. 36, Akatlar Mahallesi, Besiktas, Istanbul, Turkey
| | - Rejin Kebudi
- Department of Pediatric Hematology and Oncology, Istanbul University, Institute of Oncology, Istanbul, Turkey
| | - Alaaddin Celik
- Istanbul Faculty of Medicine, Department of Pediatric Surgery, Istanbul University, Oguz Goker Caddesi, 5. Gazeteciler Sitesi, C-1 Blok No. 36, Akatlar Mahallesi, Besiktas, Istanbul, Turkey
| | - Tansu Salman
- Istanbul Faculty of Medicine, Department of Pediatric Surgery, Istanbul University, Oguz Goker Caddesi, 5. Gazeteciler Sitesi, C-1 Blok No. 36, Akatlar Mahallesi, Besiktas, Istanbul, Turkey
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Does aggressive local treatment have an impact on survival in children with metastatic rhabdomyosarcoma? Eur J Cancer 2015; 51:193-201. [DOI: 10.1016/j.ejca.2014.11.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/10/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022]
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Abstract
PURPOSE OF REVIEW Outcomes for children with cancer have steadily improved and the long-term survival for most early-stage childhood malignancies is now greater than 90%. On the contrary, the prognosis for children with metastatic cancer, though significantly improved from a generation ago, is generally still very disappointing. Surgery continues to play a role in the increasingly aggressive treatment of children with metastatic disease with the ultimate goal of prolonging survival and improving quality of life. RECENT FINDINGS Most childhood tumors are relatively rare and are therefore studied using a multi-institutional cooperative group model that standardizes protocols and pools resources and data, accounting for the remarkable progress that has been made in the care of children with cancer. In some cases, this has also allowed us to recognize the utility of certain surgical therapies and the need to further study others. SUMMARY Modern surgery and critical care allow us to consider offering children with metastatic disease more aggressive surgical options in circumstances where the data suggest the potential for long-term survival. In situations where data are lacking, children might be offered a surgical option as part of an ongoing trial.
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Affiliation(s)
- Peter Mattei
- Department of Surgery, The University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
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Pulmonary metastasectomy in pediatric/adolescent patients with synovial sarcoma: an institutional review. J Pediatr Surg 2013; 48:757-63. [PMID: 23583130 DOI: 10.1016/j.jpedsurg.2012.09.042] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 09/17/2012] [Accepted: 09/19/2012] [Indexed: 01/25/2023]
Abstract
PURPOSE Synovial sarcoma (SS) often metastasizes to the lung; however, the indications for and outcomes of pulmonary metastasectomy have not been evaluated in pediatric/adolescent patients. METHODS The records of pediatric patients (age <22years) with pathologically confirmed SS and pulmonary metastasis treated between June 1971 and May 2011 at our institution were retrospectively reviewed for the number and type of surgical metastasectomies, tumor characteristics, and survival outcomes. RESULTS Forty-one patients (mean age: 15.9years) were identified and 31 (76%) underwent at least one metastasectomy. Seventy-two resections (range, 1-8/patient) were performed. Two- and 5-year survival rates after metastasis diagnosis were 65% and 24% for patients who underwent metastasectomy. Patients who did not undergo a metastasectomy survived no more than 2years from the diagnosis of pulmonary disease (P<0.001). Longer time to progression after primary tumor resection (>1year) and complete resection of pulmonary disease correlated with greater OS (P=0.02 and P<0.001, respectively). Palliative debulking did not improve OS. Survival was unaffected by tumor histological subtype, bilateral pulmonary disease, number of surgical resections, or number and size of resected metastatic lesions. CONCLUSION Pulmonary metastasectomy may be associated with improved survival in pediatric/adolescent patients with SS and pulmonary metastases if complete resection is achieved.
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Median sternotomy for bilateral pulmonary metastasectomy in children. J Pediatr Surg 2012; 47:1345-8. [PMID: 22813794 DOI: 10.1016/j.jpedsurg.2011.09.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 09/18/2011] [Accepted: 09/21/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Complete resection of metastatic pulmonary nodules in some children may increase survival. We present a series of 16 children who underwent median sternotomy for bilateral pulmonary metastasectomy from January 1, 1999, to December 31, 2010. METHODS We reviewed the records of 16 children (3-18 years old, 12 boys, 4 girls) with bilateral pulmonary metastases who underwent median sternotomy with the intent of curative resection. All were treated with alternating single-lung ventilation and careful bilateral manual palpation for nodules. RESULTS The mean number of lesions resected was 11.6 (range, 2-33). Two patients who were found to have lesions that were too numerous to count underwent biopsy only. There were no major complications, and median length of hospital stay was 4 days. One patient had postoperative atelectasis, and another had an air leak; both were discharged on the fifth postoperative day. Seven patients have since died, 2 of whom underwent further resection for recurrent disease, with a median survival of 30 months. Nine patients are currently alive with a median follow-up of 30 months, 2 of whom have recurrent disease. CONCLUSIONS Median sternotomy allows excellent exposure of both lungs. In our series, there were no lesions that could not be resected because of inadequate exposure, including several in the left lower lobe posteriorly, and most patients were discharged within 4 days without major complications. In children with metastatic lung disease, median sternotomy is safe and avoids treatment delay and a second operation.
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Fuchs J, Seitz G, Handgretinger R, Schäfer J, Warmann SW. Surgical treatment of lung metastases in patients with embryonal pediatric solid tumors: an update. Semin Pediatr Surg 2012; 21:79-87. [PMID: 22248973 DOI: 10.1053/j.sempedsurg.2011.10.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Distant metastases regularly occur in children with solid tumors. The most affected organ is the lung. Nearly in all extracranial pediatric solid tumors, the presence of lung metastases is associated with an adverse prognosis for the children. Therefore, the correct treatment of lung metastases is essential and influences the outcome. Despite different national and international trials for pediatric tumor entities, specific surgical aspects or guidelines for lung metastases are usually not addressed thoroughly in these protocols. The aim of this article is to present the diagnostic challenges and principles of surgical treatment by focusing on the influence of surgery on the outcome of children. Special points of interest are discussed that emphasize sarcomas, nephroblastomas, hepatoblastomas, and other tumors. Surgery of lung metastases is safe, has a positive impact on the patients' prognosis, and should be aggressive depending on the tumor entity. An interdisciplinary approach, including pediatric oncology and radiology, is mandatory in any case.
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Affiliation(s)
- Joerg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, Children's Hospital, University of Tübingen, Tuebingen, Germany.
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Huang TT, Hudson MM, Stokes DC, Krasin MJ, Spunt SL, Ness KK. Pulmonary outcomes in survivors of childhood cancer: a systematic review. Chest 2011; 140:881-901. [PMID: 21415131 PMCID: PMC3904488 DOI: 10.1378/chest.10-2133] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Accepted: 03/01/2011] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The purpose of this article is to summarize the literature that documents the long-term impact of cancer treatment modalities on pulmonary function among survivors of cancer and to identify potential areas for further research. METHODS Systematic reviews of clinical trials, observational studies, case series, and review articles were conducted. Articles were limited to the studies that discussed pulmonary toxicity or late effects among pediatric cancer survivors and to follow-up investigations that were conducted a minimum of 2 years after completion of cancer-related treatment or 1 year after hematopoietic stem cell transplant. RESULTS Sixty publications (51 clinical studies/reports and nine reviews) published from January 1970 to June 2010 in PubMed met the inclusion criteria. Data showed an association between radiotherapy, alkylating agents, bleomycin, hematopoietic stem cell transplant, and thoracic surgery and pulmonary toxicity, as well as possible interactions among these modalities. CONCLUSIONS Pulmonary toxicity is a common long-term complication of exposure to certain anticancer therapies in childhood and can vary from subclinical to life threatening. Pulmonary function and associated loss of optimal exercise capacity may have adverse effects on long-term quality of life in survivors. Lung function diminishes as a function of normal aging, and the effects of early lung injury from cancer therapy may compound these changes. The information presented in this review is designed to provide a stimulus to promote both observational and interventional research that expands our knowledge and aids in the design of interventions to prevent or ameliorate pulmonary late effects among survivors of childhood cancer.
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Affiliation(s)
- Tseng-Tien Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Dennis C Stokes
- Department of Pediatric Pulmonary Medicine, St. Jude Children's Research Hospital, Memphis, TN
| | - Matthew J Krasin
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN
| | - Sheri L Spunt
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
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Murrell Z, Dickie B, Dasgupta R. Lung nodules in pediatric oncology patients: a prediction rule for when to biopsy. J Pediatr Surg 2011; 46:833-7. [PMID: 21616236 DOI: 10.1016/j.jpedsurg.2011.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 02/11/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to develop a prediction rule regarding the factors that most accurately predict the diagnosis of a malignancy in a lung nodule in the pediatric oncology patient. METHODS A retrospective review of pediatric oncology patients that underwent lung nodule resection between 1998 and 2007 was performed. Multivariable logistic regression was used to create a prediction rule. RESULTS Fifty pediatric oncology patients underwent 21 thoracotomies and 48 thoracoscopies to resect discrete lung nodules seen on computed tomographic scans during workup for metastasis or routine surveillance. The mean nodule size was 10.43 ± 7.08 mm. The most significant predictors of malignancy in a nodule were peripheral location (odds ratio [OR], 9.1); size between 5 and 10 mm (OR, 2.78); location within the right lower lobe (OR, 2.43); and patients with osteosarcoma (OR, 10.8), Ewing sarcoma (OR, 3.05), or hepatocellular carcinoma (OR, 2.38). CONCLUSIONS Lesions that are between 5 and 10 mm in size and peripherally located in patients with osteosarcoma, Ewing sarcoma, or hepatocellular carcinoma are most likely to be malignant. Use of a prediction rule can help guide clinical practice by determining which patients should undergo surgical resection of lung nodules and which patients may be closely observed with continued radiologic studies.
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Affiliation(s)
- Zaria Murrell
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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Fuchs J, Seitz G, Ellerkamp V, Dietz K, Bosk A, Müller I, Warmann SW, Schäfer JF. Analysis of sternotomy as treatment option for the resection of bilateral pulmonary metastases in pediatric solid tumors. Surg Oncol 2008; 17:323-30. [DOI: 10.1016/j.suronc.2008.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Revised: 04/18/2008] [Accepted: 05/09/2008] [Indexed: 12/22/2022]
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Meyers RL, Katzenstein HM, Krailo M, McGahren ED, Malogolowkin MH. Surgical resection of pulmonary metastatic lesions in children with hepatoblastoma. J Pediatr Surg 2007; 42:2050-6. [PMID: 18082706 DOI: 10.1016/j.jpedsurg.2007.08.030] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Accepted: 08/08/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the most common site of metastasis for hepatoblastoma is the lung, the role of thoracotomy and surgical resection of pulmonary metastasis remains uncertain. In this study, we aimed to determine the long-term outcome of patients with hepatoblastoma who have a surgical resection of pulmonary metastatic lesions. METHODS Patients with hepatoblastoma in the Children's Oncology Group INT-0098 were reviewed. Detailed reports enabling comprehensive review were available for 175 of 181 eligible patients. Prognostic factors (histology, tumor margin, surgical complications, alpha-fetoprotein) were also reviewed. RESULTS Thoracotomy for initial pulmonary metastasis: 38 patients presented with pulmonary metastasis, Children's Oncology Group stage IV. Nine of these 38 underwent thoracotomy and pulmonary metastectomy either before (2), simultaneous (5), or after (2) resection of their primary liver tumor. Eight of these 9 patients with metastectomy were long-term survivors. Thoracotomy for tumor relapse: 20 patients who had previously achieved complete tumor clearance experienced subsequent pulmonary relapse of their tumor (11 stage I or III, 9 stage IV). All 20 patients with pulmonary relapse had salvage chemotherapy; 13 also had thoracotomy and pulmonary metastectomy (8) or thoracotomy and biopsy (5). Only 4 of 13 were long-term survivors: 2 were stage I and 2 were stage IV. CONCLUSIONS As pediatric surgeons, we varied tremendously in our timing and surgical approach to the management of pulmonary metastasis in hepatoblastoma. This large multicenter review suggests that thoracotomy should be used cautiously in the management of pulmonary relapse and perhaps more aggressively in the management of metastases present at diagnosis that persist after neoadjuvant chemotherapy.
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Affiliation(s)
- Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT 84113, USA.
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Esposito C, Lima M, Mattioli G, Mastroianni L, Riccipetitoni G, Monguzzi G, Zanon G, Cecchetto G, Settimi A, Jasonni V. Thoracoscopic surgery in the management of pediatric malignancies: a multicentric survey of the Italian Society of Videosurgery in Infancy. Surg Endosc 2007; 21:1772-5. [PMID: 17356939 DOI: 10.1007/s00464-007-9246-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 10/11/2006] [Accepted: 10/25/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few reports have elucidated the role of minimally invasive surgery (MIS) for pediatric malignancies. This study aimed to review the results of a multicenter study on the management of thoracic tumors in children using MIS. METHODS A 5-year retrospective review of all MIS procedures for the treatment of pediatric malignancies performed in seven centers belonging to the Italian Society of Videosurgey in Infancy is reported. The data from 145 pediatric oncologic patients (80 girls and 65 boys) ages 30 days to 17 years (median, 7.2 years) were analyzed. Of the procedures performed, 87 were laparoscopies (60%), 55 were thoracoscopies (38%), and 3 were lumboscopies (2%). This study focused only on the results of the 55 thoracoscopic procedures performed for diagnostic purposes in 19 cases (34.6%) and for therapeutic purposes in 36 cases (65.4%). RESULTS The duration of surgery was 15 to 180 min (median, 65 min). Metastasectomies were performed for various etiologies in 31 of the 55 cases. Of the 55 patients, 5 underwent resection of a mediastinal tumor, and 19 underwent a diagnostic thoracoscopy. During a mean follow-up period of 25.6 months, 2 (3.6%) of the 55 patients experienced perioperative complications. CONCLUSIONS The role of MIS in tumor resection for children is currently limited, but may be used in individual cases when the preoperative workup shows it to be feasible. Its indication is strictly dependent on the thoracoscopic experience of the surgeon and the tumor site for preoperative imaging techniques. When the indication for thoracoscopy is correct, this approach has high therapeutic applicability (65.4% in our series). Our preliminary experience shows that careful patient selection and an appropriate level of technical skill make thoracoscopy a reasonable and safe option for the treatment of pediatric malignancies.
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Affiliation(s)
- C Esposito
- Pediatric Surgical Unit, Magna Graecia University, Catanzaro, Piazza degli Artisti 7/c, 80129, Naples, Catanzaro, Italy.
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Abstract
This article describes the historical development of pediatric pulmonary metastasectomy but demonstrates that progress has been slow in understanding its proper applications. Because many pediatric metastatic tumors are rare, surgeons have grouped together patients of different histologies for the generation and analysis of case series. By examining tumor types individually, however, it is seen that certain histologies (adrenocortical carcinoma, alveolar soft part sarcoma, osteosarcoma) mandate surgical metastasectomy for patient survival. Other pediatric tumors (Wilms tumor, Ewing's sarcoma) are radiation sensitive, and the application of metastasectomy is controversial. In the case of still other types of tumor (neuroblastoma, differentiated thyroid cancer, rhabdomyosarcoma), metastasectomy is seldom performed except in highly unusual situations. Techniques for minimally invasive biopsy and for muscle-sparing thoracotomy are described for pediatric patients.
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Affiliation(s)
- Mark L Kayton
- Division of Pediatric Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Zarroug AE, Hamner CE, Pham TH, Houghton SG, Stavlo P, Moir CR, Rodeberg DA. Bilateral staged versus bilateral simultaneous thoracotomy in the pediatric population. J Pediatr Surg 2006; 41:647-51; discussion 647-51. [PMID: 16567170 DOI: 10.1016/j.jpedsurg.2005.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIM The aim of the study was to evaluate the safety and outcomes of simultaneous bilateral thoracotomy in pediatric patients compared with traditional bilateral staged thoracotomy. METHODS This is a retrospective review of 30 consecutive patients 18 years or younger undergoing either bilateral staged or bilateral simultaneous thoracotomy between March 1994 and July 2004. Follow-up (mean, 47 months) was available for all patients. RESULTS Thirty patients (17 boys, 13 girls; average age, 12 years) underwent bilateral staged or bilateral simultaneous thoracotomy. Eighteen patients underwent staged thoracotomy, 9 patients underwent simultaneous thoracotomy, and 3 patients underwent both procedures. Diagnosis included sarcoma (n = 21), Wilms tumor (n = 4), indeterminate pulmonary nodules (n = 3), and germ cell tumor (n = 2). When we compared outcomes for patients undergoing simultaneous versus staged bilateral thoracotomy, mean hospital stay (5.2 vs 10.6 days; P < .002), intensive care unit stay (1 vs 2 nights; P < .0001), days with tube thoracostomy (4 vs 8 days; P < .0005), and time to initiation of adjuvant chemotherapy (13 vs 30 days; P < .05) were all significantly less for patients undergoing bilateral simultaneous thoracotomy. In addition, postoperative complications were less frequent in patients undergoing simultaneous versus staged thoracotomy (0 vs 3 events; P = .25). CONCLUSIONS In selected patients, bilateral simultaneous thoracotomy is safe and may lessen morbidity and hospital stay while avoiding delay in initiation of adjuvant chemotherapy.
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Affiliation(s)
- Abdalla E Zarroug
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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