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Median sternotomy for bilateral pulmonary metastasectomy in children
Jacqueline Tsai1, Peter Mattei
1General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Insights
Median sternotomy provides excellent bilateral lung exposure for pediatric pulmonary metastasectomy, enabling complete resection with minimal complications and short hospital stays. This approach is safe and effective for treating children with metastatic lung disease.
Area of Science:
- Pediatric Surgery
- Thoracic Oncology
- Surgical Oncology
Background:
- Complete resection of pulmonary metastases in children can improve survival.
- Bilateral pulmonary nodules present a surgical challenge for complete resection.
- Median sternotomy is a surgical approach for accessing both lungs.
Purpose of the Study:
- To evaluate the safety and efficacy of median sternotomy for bilateral pulmonary metastasectomy in children.
- To assess the extent of resection and patient outcomes.
- To determine if median sternotomy provides adequate exposure for complete resection of metastatic nodules.
Main Methods:
- Retrospective review of 16 children (3-18 years) with bilateral pulmonary metastases.
- Surgical procedure involved median sternotomy and bilateral pulmonary metastasectomy.
- Techniques included alternating single-lung ventilation and manual palpation for nodules.
Main Results:
- A mean of 11.6 lesions were resected per patient (range, 2-33).
- No major complications occurred; median hospital stay was 4 days.
- Nine patients are alive with a median follow-up of 30 months; seven patients have died.
Conclusions:
- Median sternotomy offers excellent bilateral lung exposure for pulmonary metastasectomy in children.
- The procedure is safe, with no unresectable lesions due to inadequate exposure.
- Median sternotomy avoids treatment delay and the need for a second operation in pediatric patients with metastatic lung disease.
Background:
Complete resection of metastatic pulmonary nodules in some children may increase survival. We present a series of 16 children who underwent median sternotomy for bilateral pulmonary metastasectomy from January 1, 1999, to December 31, 2010.
Methods:
We reviewed the records of 16 children (3-18 years old, 12 boys, 4 girls) with bilateral pulmonary metastases who underwent median sternotomy with the intent of curative resection. All were treated with alternating single-lung ventilation and careful bilateral manual palpation for nodules.
Results:
The mean number of lesions resected was 11.6 (range, 2-33). Two patients who were found to have lesions that were too numerous to count underwent biopsy only. There were no major complications, and median length of hospital stay was 4 days. One patient had postoperative atelectasis, and another had an air leak; both were discharged on the fifth postoperative day. Seven patients have since died, 2 of whom underwent further resection for recurrent disease, with a median survival of 30 months. Nine patients are currently alive with a median follow-up of 30 months, 2 of whom have recurrent disease.
Conclusions:
Median sternotomy allows excellent exposure of both lungs. In our series, there were no lesions that could not be resected because of inadequate exposure, including several in the left lower lobe posteriorly, and most patients were discharged within 4 days without major complications. In children with metastatic lung disease, median sternotomy is safe and avoids treatment delay and a second operation.
