Twenty-seven cases of thoracic neuroblastoma were reviewed. Thirteen cases (48%) survived, 11 for more than 2 years and two for more than 14 months. Surgery is the treatment of choice and complete excision appears to give the best result. However, radical surgery is discouraged if the tumour is not readily removable. The use of chemotherapy and radiotherapy should be limited to Stage 111 and Stage 1' 1 disease and for palliation of soft tissue and bony secondaries. The clinical presentation was generally non-specific with respect to the final diagnosis in this series. Significantly raised catecholamines were seen in 13 of 16 patients assessed (81%). Prognosis was related to the age at diagnosis, stage of disease and the histological type. The better prognosis seen in thoracic neuroblastoma in comparison with abdominal neuroblastoma may be related to the earlier presentation of the disease and the higher incidence of better differentiated tumours in the thorax. There appears to be an unknown additional factor that confers a better prognosis in patients under 1 year old.
The first gastric tube oesophagoplasty at the Royal Alexandra Hospital for Children was performed in 1968. Over the next 15 years, until 1982, a total of 46 operations were performed. This represents the largest series of gastric tube oesophagoplasty in children yet reported in the literature. Two techniques have been in use and are compared. The main aim of the paper is to present the long-term results of gastric tube oesophagoplasty. In our 15 years' experience with the gastric tube for oesophageal replacement, we have found it to be a very satisfactory procedure, with a very low mortality and failure rate. The vascularity of the stomach gives rise to less anxiety than with colon. Early postoperative complications are readily identified and treated. There is a higher risk of serious chest complications in bringing the gastric tube through the chest with primary anastomosis in the neck. This also predisposes to diaphragmatic herniation and obstruction, complications not seen when the gastric tube is brought up substernally. The long-term results are very encouraging, with virtually all the children leading active and normal lives. The gastric tube functions satisfactorily with no evidence of the late complications often reported with colonic tubes. There is no significant difference in the long-term results of the two techniques of gastric tube oesophagoplasty used in this hospital.
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