Surgical approaches, anaesthetic management and outcome in pediatric superior mediastinal tumors

Ahmed, Gehad; Hegazy, Mohammed; Raafat, Tarek; Hafez, Hanafy; Fadel, Sayed; Elshafiey, Maged M.

doi:10.1016/j.jnci.2017.08.001

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…In the trans manubrial osteo muscular-sparing technique, widespread by Grunenwald, the incision extends from the thyroid cartilage, downward along the anterior margin of the sternocleidomastoid muscle, to the manubrium and the upper sternum. It is then prolonged with an anterior thoracotomy at the level of the second rib [7,8]. This approach allows a good control of the supra-aortic vessels and nerves through the thoracic inlet and a safe resection of the neoplastic mass [9,10].…”

Section: Resultsmentioning

confidence: 99%

“…When referring to thoracic NBs, the main traditional approach is posterolateral thoracotomy, which provides good access to the mediastinum (Figure 1A). Disadvantages of this approach include the risk of dysfunctions of ipsilateral shoulder and arm, of compromising the pulmonary function and of chronic post-thoracotomy pain syndromes [8]. In order to avoid these sequelae, minimally invasive surgery is emerging for these tumors.…”

Section: Resultsmentioning

confidence: 99%

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Surgical Approaches to Neuroblastoma: Review of the Operative Techniques

et al. 2021

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Neuroblastoma (NB) is the most commonly occurring soft-tissue malignancy of childhood. Surgery plays an important role in multidisciplinary treatment and its principal aim is a local control of the disease, respecting the integrity of the surrounding structures. There is no unanimous consensus on the best surgical technique, and the operative approach largely depends on the anatomical location and the extension of the mass. To have a complete overview of the different type of treatment, we made a review of the literature from the last twenty years of all the surgical approaches applied for NBs resection, accordingly to the anatomical site.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Surgical Approaches to Neuroblastoma: Review of the Operative Techniques

et al. 2021

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“…Due to disease rarity, discovery of pediatric thymoma is often an incidental finding on chest radiograph or CT [5]. A contrasted chest CT best evaluates anterior mediastinal masses in the ED; this particular imaging modality allows for differentiation of the mass, location in comparison to local anatomical structures, characterization of the mass, and aid in surgical planning [2,3,5,9]. Referral for biopsy after CT further classifies and stages mediastinal masses, determining the need for adjunctive chemotherapy and further evaluation for metastasis.…”

Section: Discussionmentioning

confidence: 99%

Cardiomegaly Masquerading as a Pediatric Thymoma: A Case Report

Figlewicz¹,

Bridwell²,

Beal³

et al. 2020

Cureus

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Thymoma is a very rare pediatric tumor, accounting for less than 1% of all childhood mediastinal tumors with scant literature, and only 23 pediatric cases were identified by a pediatric tumor surveillance registry between 1973 and 2008. In contrast to adult thymomas, pediatric thymomas have an aggressive tendency, though the majority is discovered as incidental findings. Patient presentations to the emergency department (ED) are often subtle and non-specific such as dyspnea, cough, and chest pain, requiring a broad differential on the part of the emergency clinician. Because of this presentation, diagnosis often occurs later in the disease process when compared with adults. Chest radiograph may demonstrate an enlarged thymic shadow or cardiomegaly, necessitating further cardiac workup, commonly routed through cardiology. Computed tomography and biopsy are required for definitive diagnosis, requiring a multidisciplinary approach to management. We present a case of a 16-year-old female complaining of progressive dyspnea and chest pain over the course of one to two months with radiographic cardiomegaly. She was found to have a Masaoka stage III World Health Organization (WHO) type B3 thymic endothelial neoplasm and underwent surgical resection.

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“…The incision for thoracotomy is based on the position of the tumor. The children's chest is elliptical and elastic, which avails to easy and clear exposure of the tumor (11). Also, thoracotomy is a comparatively simple procedure and can be applied for large tumors and severe thoracic adhesion.…”

Section: Discussionmentioning

confidence: 99%

Comparison of efficacy between video-assisted thoracoscopic surgery and thoracotomy in children with mediastinal tumors: 6-year experience

Peng

et al. 2019

Ann. Transl. Med.

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Background: Video-assisted thoracic surgery (VATS) has been increasingly used in pediatric patients. We evaluated the outcomes of VATS and thoracotomy for pediatric mediastinal tumors. Methods: A total of 137 patients who underwent surgery for mediastinal tumors at our department from March 2012 to September 2018 were recruited in this retrospective study. Forty-three patients were treated by VATS and ninety-four underwent thoracotomy (two patients who underwent open surgery were excluded from the study because they were lost to follow-up). Data including demographic information, tumor characteristics, operative time, conversion of surgery, blood transfusion, postoperative hospital stay, mortality and recurrence were collected and compared between the two groups.Results: No significant difference was found in gender, age, weight and tumor distribution between the two groups. The number of patients with malignant tumors who underwent thoracotomy was significantly higher than those who received VATS (78.0% vs. 22.0%, P=0.04). Patients received thoracotomy had significantly larger mean tumor diameter than those who underwent VATS (7.6±3.8 vs. 4.4±1.7 cm, P<0.001).The intraoperative transfusion rate in the thoracotomy group was significantly higher than that in the VATS group (67.4% vs. 14.0%, P<0.001), so was the amount of blood transfusion (148.1±150.7 vs. 23.3±61.1 mL, P<0.001). The VATS group had significantly shorter operative time as compared with the thoracotomy group (94.3±40.9 vs. 133.5±72.1 min, P=0.002). During follow-up, local recurrence was found in 8 (8.7%) patients who underwent thoracotomy, and no significant difference was found in local recurrence rate between the two groups. Four patients who underwent thoracotomy died, and no significant difference was found in mortality between two groups.Conclusions: Due to less blood transfusion, shorter operative time and postoperative hospital stay, VATS is a safer surgical treatment for pediatric mediastinal tumors than thoracotomy.

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Surgical approaches, anaesthetic management and outcome in pediatric superior mediastinal tumors

Cited by 5 publications

References 14 publications

Surgical Approaches to Neuroblastoma: Review of the Operative Techniques

Surgical Approaches to Neuroblastoma: Review of the Operative Techniques

Cardiomegaly Masquerading as a Pediatric Thymoma: A Case Report

Comparison of efficacy between video-assisted thoracoscopic surgery and thoracotomy in children with mediastinal tumors: 6-year experience

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