Median sternotomy for bilateral pulmonary metastasectomy in children

Tsai, Jacqueline; Mattei, Peter

doi:10.1016/j.jpedsurg.2011.09.057

Cited by 7 publications

(8 citation statements)

References 13 publications

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“…Thanks to the experience of thoracic surgeons, an alternative treatment was proposed to avoid two consecutive anesthesias and the consequent risks of thoracic surgery, as well as to shorten the delay before administration of adjuvant chemotherapy, when required. This treatment included bilateral simultaneous thoracotomy or median sternotomy [8,9,11]. However, no reports exist on experiences with BAT in children or adolescents with this indication.…”

Section: Discussionmentioning

confidence: 99%

“…It was hypothesized that a one-stage approach could lead to better outcomes, as it avoids a second procedure (including anesthetic risks) and reduces the delay before administration of adjuvant chemotherapy. This one-stage approach has been reported in the pediatric population [8,9,11]. …”

Section: Discussionmentioning

confidence: 99%

“…However, conversely, Tsai et al . [8] reported a better exploration of the left lower lobe, without recurrence of metastasis in this area. Our study revealed that BAT offers good access to both lungs, avoids certain physiopathologic inconveniences, and does not require a change of the patient’s position during surgery, as it does during bilateral simultaneous PLT.…”

Section: Discussionmentioning

confidence: 99%

“…In the longer scenario, adjuvant therapies were then postponed for a further month. For these reasons, one-stage procedures such as median sternotomy [8] or bilateral simultaneous thoracotomy [9] have been proposed, but we found no data concerning bilateral anterior thoracotomy (BAT) for this indication in the relevant pediatric literature.…”

Section: Introductionmentioning

confidence: 99%

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Bilateral anterior sternothoracotomy (clamshell incision): a suitable alternative for bilateral lung sarcoma metastasis in children

et al. 2014

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BackgroundThe aim of our study was to assess the postoperative course of bilateral anterior sternothoracotomy (BAT) in children with sarcoma metastases, in a curative care perspective.MethodsWe reviewed the records of seven patients younger than 18 years old, who underwent surgical procedures for sarcoma metastasis to the lung between 2000 and 2012. We compared the postoperative course of the BAT group with that of patients who underwent unilateral posterolateral thoracotomies (PLTs) for the same etiology.ResultsOf 17 surgical procedures, there were seven BAT and 10 unilateral PLT. Mean ages at the time of the procedures were 12.9 ± 5.4 years old for BAT, and 17.4 ± 1.9 years old for PLT. Mean operative time was 173 ± 37 minutes in the BAT group, and 145 ± 39 minutes in the PLT group (P = 0.19). Patients received epidural analgesia in all cases; this was for a mean time of 3.8 ± 1.3 days in the BAT group, and 3.21 ± 4 days in the PLT group (P = 0.36). Chest tubes were removed after 3.6 ± 1.3 days in the BAT group, and 3 ± 1.2 days in the PLT group (P = 0.69). Total hospital stay was 7.7 ± 6.6 days in the BAT group, and 7 ± 1.2 days in the PLT group (P = 0.72).ConclusionIn our experience, BAT seems suitable and shows outcomes similar to those of PLT for sarcoma metastasis resection. The BAT procedure allows the manual exploration of both lungs during a single surgical intervention, and so reduces the delay of further therapies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bilateral anterior sternothoracotomy (clamshell incision): a suitable alternative for bilateral lung sarcoma metastasis in children

et al. 2014

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“…At present, local and international studies (Ismail et al, 2012;Tsai and Mattei, 2012) have shown that the survival rates of patients with HB treated with chemotherapy, interventional therapy, surgery, and APBSCT have been significantly improved, with 5-year survival rate of about 70%. However, the survival rate of patients accompanied by distant organ and tissue metastases is still unsatisfactory; the lowest value of the survival rate is only 15% to 20%.…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy and Prognosis Factors for Advanced Hepatoblastoma in Children: A 6-year Retrospective Study

Zhang

Zhang²,

Huang³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Objective: This study aimed to investigate the effect of multimodality treatment of advanced paediatric hepatoblastoma (HB) and the factors affecting prognosis. Methods: A total of 35 children underwent multimodality treatments consisting of chemotherapy, surgery, interventional therapy, and autologous peripheral blood stem cell transplantation. The patients were followed up every month. Results: Serum AFP levels in 33 out of 35 patients in this study were significantly increased (P = 0.0002). According to the statistical scatter plot, the values of serum AFP on the 25th, 50th, and 75th percentages were 1,210, 1,210 and 28,318 ng/dl, respectively. Of the 35 cases, 21 were stage IV. 18 cases were treated with systemic chemotherapy before surgery, and 3 cases with locally interventional chemotherapy before surgery. Statistical analysis showed that the preferred interventional treatment affected prognosis, and that there was a statistically significant difference (P = 0.024). Some 33 patients completed the follow-up, of which 17 were in complete remission (CR), 5 were in partial remission (PR), 1 became disease progressive (DP) , and 10 died. The remission and overall survival rates were 66.7% (22/33) and 69.7% (23/33), respectively. Patients with the mixed HB phenotypes had worse prognoses than the epithelial phenotype (P < 0.001), and patients in stage IV had a lower survival rate than those in stage III (P < 0.001). Conclusion: Multimodality treatment can effectively improve remission rate and prolong the survival of children with advanced HB. In addition, alpha-fetoprotein (AFP), a tumor marker of liver malignant tumors, HB pathological classification, and staging are highly useful in predicting prognosis.

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