Current Role for Resection of Thoracic Metastases in Children and Young Adults - Do we Need Different Strategies for this Population?

Torre, W.; Rodríguez-Spiteri, N.; Sierrasesúmaga, Luis

doi:10.1055/s-2004-817811

Cited by 18 publications

(4 citation statements)

References 15 publications

(15 reference statements)

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“…Further progress was made when wedge resection was popularized by Kilman et al, allowing for resection of multiple bilateral lung lesions with maximal preservation of lung function 4 . Unfortunately, analysis of the outcome of pulmonary metastasectomy was impossible in many of the early series because most series from the 1960s through 2000 grouped multiple histologies together 2,3,4,5 . Some early series avoided this pitfall 6 and some brought attention to it by showing the effect of histology on outcome 7 .…”

Section: Historical Perspectivementioning

confidence: 99%

Surgical treatment of pulmonary metastases in pediatric solid tumors

Heaton

Davidoff

2016

Seminars in Pediatric Surgery

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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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Section: Historical Perspectivementioning

confidence: 99%

Surgical treatment of pulmonary metastases in pediatric solid tumors

Heaton

Davidoff

2016

Seminars in Pediatric Surgery

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“…We chose a second thoracotomy for our bilateral tumor cases rather than the bilateral simultaneous approach [ 12 ] utilized by Torre et al In only two of our cases did we choose to perform a sternotomy incision and bilateral metastasectomy.…”

Section: Discussionmentioning

confidence: 99%

“…They suffered one early postoperative loss due to pneumonia, and four patients died later due to late metastases (mean of 29 months later). The overall mortality of their series was 25 % [ 12 ]. Hacker et al evaluated 10 pulmonary metastasectomy patients, and during a mean follow-up period of 49 months, 8 patients (80 %) remained in complete remission [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Pulmonary metastasectomy in pediatric patients

et al. 2015

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BackgroundThis study aims to evaluate the outcomes of pulmonary metastasectomy resections in pediatric patients.MethodsWe 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.ResultsIndications 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 %.ConclusionsMultidisciplinary 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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“…In 1969, Kilman et al popularized the wedge resection, which allowed multiple bilateral lung lesions to be resected while preserving maximal lung function [5]. Because most published series from 1960 to 2000 grouped multiple histologies together, analysis of outcome after pulmonary metastasectomy was impossible [2,3,4,5,6]. Some studies avoided this problem by focusing only on one histology [7], and some shed light on this problem by showing the difference in outcomes between histologies [8].…”

Section: Historical Perspectivementioning

confidence: 99%

Pulmonary Metastasectomy in Pediatric Solid Tumors

Croteau

Heaton

2019

Children

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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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Current Role for Resection of Thoracic Metastases in Children and Young Adults - Do we Need Different Strategies for this Population?

Abstract: A close collaboration between oncologists, radiotherapists, and surgeons is mandatory in order to obtain good results. IORT is an interesting option. Better results are obtained if there is a long DFI and probably justifies a more aggressive approach in these specific cases.

Cited by 18 publications

References 15 publications

Surgical treatment of pulmonary metastases in pediatric solid tumors

Surgical treatment of pulmonary metastases in pediatric solid tumors

Pulmonary metastasectomy in pediatric patients

Pulmonary Metastasectomy in Pediatric Solid Tumors

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