Median sternotomy for the resection of bilateral pulmonary metastases in children

Abstract

Childhood cancer often results in pulmonary metastases, and proper identification and prompt treatment of these lesions increases the survival of these patients. Between 21 May 1995 and 26 June 1996, nine children (five with osteosarcoma, two with Wilms' tumor, and one each with hepatoblastoma and an adrenocortical tumor) underwent median sternotomy at our institution for resection of bilateral pulmonary metastases. These five boys and four girls ranged in age from 2 to 16 years (median, 11 years). Identification and resection of metastases in all lobes of the lungs was greatly facilitated by the median sternotomy approach because both thoracic cavities were fully accessible. In each of five patients, as many as 23 metastases were removed using wedge resection or a stapling device. Multiple biopsies only were obtained from the four remaining patients, whose lesions were too numerous and diffuse for effective resection. All nine patients recovered uneventfully; the median hospitalization was 3 days (range, 2-5 days). We find that median sternotomy is a safe, effective, and relatively simple procedure for resecting bilateral pulmonary metastases in children with cancer.

The Relevance of Surgical Therapy for Bilateral and/or Multiple Pulmonary Metastases in Children

“…Our results confirmed this experience and corroborate the concept of using open surgery. Some authors recommend a median sternotomy for routine bilateral lung exploration [8]. In our and others [16] experience, a lateral thoracotomy allows a better access to basal and posteriorly located lung segments as well as to lymph nodes.…”

Median sternotomy for bilateral pulmonary metastasectomy in children

“…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.…”

“…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].…”