Analysis of sternotomy as treatment option for the resection of bilateral pulmonary metastases in pediatric solid tumors

Fuchs, Jörg; Seitz, Guido; Ellerkamp, Verena; Dietz, Klaus; Bosk, Axel; Müller, Ingo; Warmann, Steven W.; Schäfer, Jürgen

doi:10.1016/j.suronc.2008.05.004

Cited by 33 publications

(40 citation statements)

References 15 publications

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“…However, a recent study that analysed the use of sternotomy for bilateral disease found that preoperative computed tomography scan assessment of number of metastases matched the actual number found intraoperatively in only 13 of 16 cases. [13] This study highlighted the importance of tactile assessment to increase the chance of finding and resecting metastatic deposits, particularly when compared with endoscopic techniques. The left lower lobe is the most difficult area to assess via the sternotomy approach.…”

Section: Resultsmentioning

confidence: 94%

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The versatility of median sternotomy in general paediatric surgery

et al. 2013

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Background. While common in cardiac surgery, median sternotomy (MS) is rarely required in general paediatric surgery. In the era of advancing endoscopic techniques, sternotomy is perceived as an extremely invasive incision, associated with prolonged postoperative recovery and significant morbidity. Methods. We conducted a retrospective chart review of all children undergoing MS for non-cardiac indications between January 2007 and September 2012 and describe the pathology, number of ventilated days, duration of intensive care unit stay and analgesic requirements. Results. Our experience over the past 6 years includes 14 children, aged between 8 months and 13 years. Indications for surgery included penetrating mediastinal trauma (1), anterior and posterior mediastinal masses (4), acquired tracheo-oesophageal fistulas secondary to button battery impaction (2), bronchial foreign bodies (2) and bilateral pulmonary metastases secondary to malignancy (5). The range of postoperative ventilation required was 0 -34 days (median 1 day) and the range of duration of stay in the paediatric intensive care unit 1 -39 days (median 4 days). Postoperative analgesia was provided with intravenous or oral paracetamol with or without the addition of morphine. All the children tolerated the procedure well with no sternotomy-related complications on follow-up. Conclusion. This review highlights the variety of conditions in which MS provides unrivalled access to the mediastinum and how well the procedure is tolerated by the paediatric patient, and emphasises the importance of sternotomy being within the armamentarium of access techniques of the general paediatric surgeon.

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Section: Resultsmentioning

confidence: 94%

“…The left lower lobe is the most difficult area to assess via the sternotomy approach. [13] Our series includes 5 patients who presented with bilateral lung metastases, 3 of which were secondary to nephroblastoma and 1 each to embryonal sarcoma of the liver and osteosarcoma of the femur (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

The versatility of median sternotomy in general paediatric surgery

et al. 2013

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“…This approach allows for palpation of nodules in both lungs, which is paramount in identifying lesions that may not have been identified on CT [10,[13][14][15]. Computed tomography is considered the current radiographic gold standard in identifying and localizing metastatic lesions.…”

Section: Discussionmentioning

confidence: 99%

“…These studies found no increase in complications or mortality or decrease in overall survival [11]. More recently, several authors have described this approach in children as a safe method that provides simultaneous access to both hemithoraces with no increase in operative morbidity or mortality in children [13][14][15].…”

mentioning

confidence: 95%

Median sternotomy for bilateral pulmonary metastasectomy in children

Tsai

Mattei

2012

Journal of Pediatric Surgery

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“…We believe that the use of HPCT has a relevant clinical impact in patients with pulmonary metastases. Fuchs et al observed a lower number of pulmonary metastases in preoperative MDCT in 5 of 16 tumor patients compared to intraoperative status [13]. Grundy et al have shown that Wilms' tumor patients with metastatic lung disease undergoing therapy with 3 instead of 2 drugs have an improved five-year event-free survival compared to patients with metastases detected by chest radiograph (80 % vs. 56 %) [14].…”

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confidence: 99%

High-Pitch Computed Tomography of the Lung in Pediatric Patients: An Intraindividual Comparison of Image Quality and Radiation Dose to Conventional 64-MDCT

Tsiflikas

Thomas

Ketelsen

et al. 2014

Fortschr Röntgenstr

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The aim of this study was to investigate frequencies of typical artifacts in low-dose pediatric lung examinations using high-pitch computed tomography (HPCT) compared to MDCT, and to estimate the effective radiation dose (E eff ). Materials and Methods: Institutional review board approval for this retrospective study was obtained. 35 patients (17 boys, 18 girls; mean age 112 ± 69 months) were included and underwent MDCT and follow-up scan by HPCT or vice versa (mean follow-up time 87 days), using the same tube voltage and current. The total artifact score (0 -8) was defined as the sum of artifacts arising from movement, breathing or pulsation of the heart or pulmonary vessels (0 -no; 1 -moderate; 2 -severe artifacts). E eff was estimated according to the European Guidelines on Quality Criteria for Multislice Computed Tomography. The Mann-Whitney U test was used to analyze differences between the patient groups. The Spearman's rank correlation coefficient was used for correlation of ordinal variables. Results: The scan time was significantly lower for HPCT compared to MDCT (0.72 ± 0.13 s vs. 3.65 ± 0.81s; p < 0.0001). In 28 of 35 (80 %) HPCT examinations no artifacts were visible, whereas in MDCT artifacts occurred in all examinations. The frequency of pulsation artifacts and breathing artifacts was higher in MDCT compared to HPCT (100 % vs. 17 % and 31 % vs. 6 %). The total artifact score significantly correlated with the patient's age in MDCT (r = -0.42; p = 0.01), but not in HPCT (r = -0.32; p = 0.07). The estimated E eff was significantly lower in HPCT than in MDCT (1.29 ± 0.31 vs. 1.47 ± 0.37 mSv; p < 0.0001). Conclusion: Our study indicates that the use of HPCT has advantages for pediatric lung imaging with a reduction of breathing and pulsation artifacts. Moreover, the estimated E eff was lower. In

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Analysis of sternotomy as treatment option for the resection of bilateral pulmonary metastases in pediatric solid tumors

Cited by 33 publications

References 15 publications

The versatility of median sternotomy in general paediatric surgery

The versatility of median sternotomy in general paediatric surgery

Median sternotomy for bilateral pulmonary metastasectomy in children

High-Pitch Computed Tomography of the Lung in Pediatric Patients: An Intraindividual Comparison of Image Quality and Radiation Dose to Conventional 64-MDCT

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