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Thoracic surgery in children
Peter Kanngiesser1, Florian Liewald, Gisela Halter
1Department of Thoracic and Vascular Surgery, Universitätsklinikum Ulm., Steinhövelstr. 9, 89070 Ulm, Germany. peterkanngiesser@bdc.de
Insights
Pediatric thoracic surgery is rare but successful for benign conditions, offering good quality of life. Oncologic cases show promise, but caution is advised for immunodeficient patients due to high mortality risks.
Area of Science:
- Pediatric Thoracic Surgery
- Pediatric Oncology
- Pediatric Immunology
Background:
- Thoracic surgical procedures in children are infrequent and categorized into oncologic, immune defects, malformations, infections, and trauma.
- Anatomical differences in children necessitate modified diagnostic and surgical techniques compared to adults.
Purpose of the Study:
- To analyze the outcomes of thoracic surgical procedures performed in children.
- To evaluate the safety, efficacy, and quality of life associated with pediatric thoracic surgery.
Main Methods:
- Retrospective analysis of 49 thoracic surgical procedures performed on 37 children (3 months-15 years) between 1992 and 2001.
- Indications included oncologic disease (n=20), immunodeficiency (n=5), malformations (n=6), and trauma (n=3).
- Postoperative clinical course, pulmonary function tests (n=16), and quality of life (Karnofsky index, n=24) were assessed.
Main Results:
- Procedures included atypical resections (n=27), lobectomies (n=7), pneumonectomy (n=1), decortications (n=3), and mediastinotomies (n=4).
- Two of six patients with immune defects died perioperatively; 55% of oncologic patients remained disease-free.
- Quality of life scores were high (≥80% Karnofsky index) in 24 children.
Conclusions:
- Pediatric thoracic surgery for benign conditions yields favorable prognoses and high quality of life.
- Surgical treatment of pulmonary metastases is a viable oncologic therapy option for selected children.
- Diagnostic thoracotomies in immunocompromised children require critical risk-benefit assessment due to high perioperative mortality.
Objective:
Children rarely undergo thoracic surgery. When they do, the procedures fall into five main groups: oncologic indications, immune defects, malformations, infections and trauma. In addition to considerations associated with the underlying indication, the different proportions of the anatomical structures in children require special modifications in both diagnostics and surgical technique compared to corresponding procedures in adults.
Methods:
Of a total 2137 thoracic surgical procedures performed between 1992 and 2001, 49 were performed in children (n = 37; age: 3 months-15 years; median age: 8 years). Indications for surgery included underlying oncologic disease (n = 20), immunodeficiency (n = 5), thoracic or pulmonary malformation (n = 6) and trauma (n = 3). Patients' postoperative clinical course was analyzed retrospectively for all 49 procedures. Pre- and postoperative pulmonary function test results are available for 16 children. Data regarding quality of life were documented in 24 children.
Results:
The following procedures were performed: 27 atypical resections, seven lobectomies, one pneumonectomy, three decortications, four mediastinotomies or mediastinoscopies and seven other procedures. Six procedures represented second or third procedures in the same patient. Two of six patients with immune defects died during the perioperative period. Eleven of 20 oncologic patients (55%) have remained free of recurrent disease. Quality of life, as assessed by the Karnowski index in 24 children, was at least 80%.
Conclusions:
Thoracic surgical procedures in children with underlying benign disease are associated with a good prognosis and high quality of life scores. Surgical treatment of pulmonary metastases is a feasible component of the overall oncologic therapy concept and can offer the only opportunity for curation for a selected group of patients. Because of high postoperative mortality, however, the indication for diagnostic thoracotomies in children with immunodeficiencies and poor general health should be weighed critically.
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