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Is thoracoscopy for mediastinal tumors in children efficient and safe?

Majid Alkhamis¹, François Varlet², Manuel Lopez², Hélène Martelli¹, Philippe Montupet¹, Guérin Florent¹

¹CHU Bicêtre, Le Kremlin Bicêtre, France, ²Hôpital Nord, St-Etienne, France

  

Abstract 

Aim: To better define the place of thoracoscopy and its efficiency for resection of mediastinal tumours in children.
Methods: Retrospective review of two centres experience (Apr 2000-Feb 2013). Twenty two patients (pts) aged from 5 months to 16 years old (median: 7 years). All underwent thoracoscopy for a solid or partially cystic mediastinal tumour. Seventeen had a lesion located in the posterior mediastinum (neurogenic tumors), 2 in the mid-mediatinum (lymphomas), and 3 in the thymus. Median size of the lesions was 31mm (15-80). The approach was right (n=10) and left sided (n=12).
Results: Two conversions in thoracotomies were necessary (1 tumour fragmentation, 1 difficulty during dissection). The resection was macroscopically incomplete for a thymic nodule (adhesion to the vena cava). Six patients had fragmentation of their tumour. The median operative time was 130 min (60-210). A chest tube was left for a median of 2 days (1-4) in 19 patients. Median length of hospital stay was 4 days (2-9). Pathology showed 16 neurogenic tumors, 1 para-vertebral extramedullary hematopoiesis, 2 necrotic lesions in the mid- mediastinum, and 3 anterior mediastinum lesions (1 teratoma, 1 lymphangioma, and a necrotic nodule). The resection was microscopically complete in 19 cases, microscopically incomplete in 2, and macroscopically incomplete in 1. One child developed a right pneumothorax and was re-operated at day13 post-op. Two patients with neuroblastoma developed a Claude-Bernard-Horner syndrome. There were 3 cases of local relapses of neuroblastomas: 1 was peroperativally fragmented and 2 had a microscopically incomplete resection. Median size of lesions was the same for patients with recurrence as patients without: 40mm [23-80] P=0.5.
Conclusion: Thoracoscopy for mediastinal tumors allows 83% of complete resection for lesions smaller than 80mm. However, in case of neuroblastoma, resection should be complete and without intraoperative fragmentation.