Pulmonary metastasectomy for pediatric solid tumors.

Area of Science:

• Pediatric Oncology
• Thoracic Surgery
• Surgical Oncology

Background:

• Pediatric thoracic malignancy often presents as pulmonary disease secondary to childhood solid tumors.
• Management of isolated pulmonary metastases in adults is established, but long-term outcomes in children are less documented.

Purpose of the Study:

• To assess the long-term outcomes of pulmonary metastasectomy in pediatric patients with isolated pulmonary metastases.
• To evaluate the safety and efficacy of surgical intervention for lung metastases in children.

Main Methods:

• Retrospective study of 20 children undergoing surgery for isolated pulmonary metastases over 12 years.
• Analysis of patient demographics, tumor types (Wilms' tumor, osteogenic sarcoma, rhabdomyosarcoma, hepatoblastoma, teratoma), surgical procedures, and follow-up data.
• Inclusion of preoperative imaging (contrast-enhanced CT of head and chest, chest X-ray) in assessment.

Main Results:

• 16 out of 20 children remain alive and well with a mean follow-up of 8 years.
• 19 children were discharged within 10 days of surgery, indicating good tolerance.
• One early complication (pneumonia) and four late deaths due to cranial metastases were reported.

Conclusions:

• Results support an aggressive surgical approach for isolated pulmonary metastases in children as part of combined therapy.
• Bilateral synchronous and metachronous thoracotomy is well tolerated in the pediatric population.
• Comprehensive preoperative assessment, including advanced imaging, is crucial for surgical planning.