[Thoracoscopic resection of lung metastases guided by hook wire]

To describe our experience in the use of the guided hook wire placement to undergo thoracoscopic resection of pulmonary metastases in children.

We conducted a retrospective review, between January 2008 and December 2014 of the patients that were diagnosed with pulmonary metastases by image and who underwent a thoracoscopic metastasectomy. Patients in whom a CT- guided hook was done before the surgery were included.

Eleven procedures were done in ten patients with a median age of 10 years (range 2-16 years). The cancer diagnoses were: 4 osteosarcoma, 1 nephroblastoma, 1 suprarrenal carcinoma, 1 liver sarcoma, 1 pseudopappilary tumor of pancreas 2 hepatoblastomas. All patients had subpleural metastases (size 2-11 mm) and only one hook was used in each procedure. 8 patients had metastases at the time of diagnosis, and the other 2 were diagnosed during the follow-up of the primary cancer. The median follow-up was 27 months (range 2-28 months). In this period, two patients had relapse of the primary tumor, with exitus. At present, the other children are free disease. The CT-guided hook wire fixation was successful and without major complications in all patients. The lesion indentified by image was resected. The result was 4 malignant lesions, and 7 benigns.

The use of the CT- guided needle and hook wire placement for the resection of the metastases lesions is a safe and effective technique. We consider it the technique to choice in case of solitary and subpleural lesions.