Surgical Treatment for Pediatric Mediastinal Neurogenic Tumors

Surgical Unit of the Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom.
The Annals of thoracic surgery (Impact Factor: 3.85). 08/2010; 90(2):413-8. DOI: 10.1016/j.athoracsur.2010.04.086
Source: PubMed


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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    • "Surgical and clinical outcomes seem superior in comparison to the open approach because patients are spared thoracotomies or sternotomies. Long-term survival of children undergoing thoracoscopic resection of mediastinal neurogenic tumors seems higher when compared with those reported for other primary neurogenic tumor localizations (20, 21). However, extensive resection with relevant risk of functional damage should not be performed in benign cases, irrespective of the treatment approach (14). "
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