Surgical treatment for pediatric mediastinal neurogenic tumors.
ABSTRACT Mediastinal neurogenic tumors are relatively rare in children, and controversies persist about the best surgical approach and long-term survival.
With ethics approval we reviewed the case notes of 43 consecutive children (22 boys) operated on for mediastinal neurogenic tumor in two different institutions from March 1998 to June 2009.
The average age at diagnosis was 3 years (range, 0.6 to 4.7 years). Of the 43 operated tumors, 20 were neuroblastomas (47%), 13 were ganglioneuroblastomas (30%), and 10 were ganglioneuromas (23%). Only 6 (14%) of these tumors were discovered incidentally; the remaining 37 (86%) presented symptomatically: cough (30%), dyspnea (21%), wheezing (11.6%), neurologic spinal compression (7%), dancing eyes syndrome (7%), and Horner syndrome (7%). Tumor resection was undertaken by open operation in 38 cases (88%) and by thoracoscopy in 5 cases (12%). The children operated on by means of thoracoscopy had significantly smaller tumors (p = 0.01) and shorter duration of thoracic drain (p = 0.011) and hospitalization (p = 0.016) than those who were operated on by thoracotomy. There was not any surgical death. Postoperative complications occurred in 11 children (25.6%). Tumor recurrence occurred in 4 children (9.3%) operated on by open surgery, and there were 2 deaths of children with neuroblastoma. The overall survival was 95.4% in an average follow-up of 3.5 years (range, 0.7 to 4.4 years).
Surgical resection of children with mediastinal neurogenic tumors treated at two international tertiary hospitals was safe, and the thoracoscopic approach was appropriate for small tumors. The long-term survival was higher when compared with those reported for other primary neurogenic tumor locations.
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ABSTRACT: The aim of this study was to evaluate the efficacy and safety of thoracoscopy in the treatment of solid thoracic tumors in children. A retrospective, multicenter review of 139 thoracoscopies was performed. The procedures were either resection of pulmonary lesions or biopsy. Complications, histologic biopsy results, and outcomes were reviewed. One hundred thirty-nine procedures were performed in 134 children. There were 72 males and 62 females, with a mean age of 9.2 years (3 months to 17 years). The mean follow-up was 4.5 years. Thirty-eight primitive tumors were managed, 20 of which had a complete thorascopic resection, and nine biopsies were performed. In 9 additional cases, an open conversion was necessary. Among the 20 complete resections, 17 of the lesions were neurogenic tumors (i.e., neuroblastoma or ganglioneuroma). Three complications occurred: 2 chylothoraces and 1 with Horner syndrome. All three complications regressed. The mean follow-up was 3 years, and no recurrence has been noted. Fifty-three metastatic lesions were managed: 29 had a complete resection, 11 had a biopsy, and an open conversion was necessary in 13 cases. Among the complete resections, more than half were metastases from bone tumors. The mean follow-up was approximately 4 years and 5 pulmonary recurrences developed. Four deaths occurred, with 2 having had lung metastases. Forty-eight malignant hemopathies were managed; 9 biopsies for primitive tumors were performed. There were 36 secondary lesions, of which 5 were completely resected; 30 were biopsied and 1 required an open conversion. Thoracoscopy is a safe, effective approach for the evaluation and resection of solid lung tumors and for biopsy. Thoracoscopic resection of metastatic lesions is reasonable for nephroblastoma, but a thoracotomy is suggested for other metastases.Journal of Laparoendoscopic & Advanced Surgical Techniques 01/2008; 17(6):825-9. · 1.07 Impact Factor
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ABSTRACT: The prognosis for thoracic neuroblastoma has been documented as good, but the reasons have not been elucidated. We reviewed our experience of patients with thoracic neuroblastoma who were treated over the past decade. Among 102 patients treated for neuroblastoma at our hospital between December 1987 and June 1997, 20 patients had thoracic neuroblastoma (stage 1: nine, stage 2: five, stage 3: three, stage 4: three). Tumor characteristics and survival rate were compared between thoracic and nonthoracic neuroblastoma. The surgical margin was positive in 13 of the 20 patients with thoracic neuroblastoma. However, local recurrence was observed in only one patient who later underwent complete resection. All patients survived 4-14 years of follow-up. Among those over 1 year old, thoracic neuroblastoma was detected at an earlier stage than in their nonthoracic counterparts (stages 1 and 2 vs. 3 and 4: 6/3 vs. 1/17, p=0.003), and the 5-year survival rate was better than in their nonthoracic counterparts (100% vs. 44.5%, p=0.015). The incidence of ganglioneuroblastoma was significantly higher in the thoracic group at the age of >1 year ( p=0.003). In six of nine patients from the thoracic group who were >1 year old, small areas of ganglioneuroma were identified in the tumor tissue. There was a stronger tendency for the maturation of neuroblastoma into ganglioneuroma in the thoracic group. Complete resection is not required for thoracic neuroblastoma regardless of the patient's age.Pediatric Surgery International 09/2004; 20(9):714-8. · 1.22 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the feasibility of thoracoscopy in neurogenic tumors in infants and children. From January 2000 to October 2005, 21 patients aged 7 months to 14 years (mean, 6 years) underwent thoracoscopy for tumor resection in 5 French institutions. One 10-mm optical port and 2 operative 5-mm ports were needed. Selective intubation was required for 3 patients aged about 12 years. Tumor was removed with an endoscopic bag in all cases. All procedures were completed successfully without any incomplete resection or recurrence. One conversion was necessary because of a huge mass. A chest tube was left for a mean of 2 days for 17 children. Two children had not had any drainage. Two postoperative chylothorax required chest drainage for 12 days. Only 5 of the 6 older patients (mean age, 12 years) needed a patient-controlled analgesia. The mean operative time was about 100 minutes. Hospital stay ranged from 4 to 12 days. Tumors were neuroblastoma or ganglioneuroblastoma in 16 cases and ganglioneuroma in the 5 other cases. Thoracoscopy for resection of thoracic neurogenic tumors in children is a feasible, safe, and efficient procedure. The surgeon has a better visualization of the tumor and its anatomic connections. Resection can be as complete as an open procedure without having to complicate the operative technique in the same operating time. It avoids cosmetic and functional disorders because of thoracotomy. It allows a good cosmetic resection without spillage.Journal of Pediatric Surgery 11/2007; 42(10):1725-8. · 1.38 Impact Factor