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Postoperative outcome following thoracotomy in the pediatric oncology patient with diminished pulmonary function
J D Tobias1, P M Bozeman, P W Mackert
1Department of Anesthesiology and Pediatrics, Vanderbilt University, Nashville, TN 37232.
Insights
Pediatric cancer patients with reduced lung function can safely undergo surgery for lung metastases. Aggressive treatment is generally well-tolerated, even with severe pulmonary dysfunction.
Area of Science:
- Thoracic Surgery
- Pediatric Oncology
- Pulmonary Medicine
Background:
- Surgical resection of pulmonary metastases is crucial in pediatric cancers.
- Limited data exists on postoperative outcomes in pediatric patients with diminished lung function.
Purpose of the Study:
- To evaluate the safety and outcomes of thoracotomy in pediatric patients with reduced pulmonary function undergoing resection of lung metastases.
Main Methods:
- Retrospective review of 32 thoracotomies in 19 pediatric patients with pulmonary function tests (PFTs) below 80% predicted.
- Analysis of preoperative and postoperative PFTs (FVC, FEV1, TLC).
- Assessment of postoperative morbidity, including prolonged oxygen need, ventilation, air leak, and mortality.
Main Results:
- Significant drops in forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were observed post-surgery.
- No correlation found between the degree of PFT decline and increased postoperative morbidity.
- Morbidity events occurred across mild, moderate, and severe pulmonary dysfunction groups, including one death in the moderate group.
Conclusions:
- Aggressive surgical treatment for pediatric pulmonary metastases is feasible and generally tolerated, even in patients with significant pre-existing lung disease.
- Postoperative outcomes do not appear to be strongly correlated with specific PFT values.
- Further research is needed to fully elucidate risks in this population.
Abstract:
Surgical resection of pulmonary metastatic disease is often indicated in pediatric malignancies. Although several adult studies document increased postoperative morbidity in adults with diminished pulmonary function, there is little information in the pediatric population or in patients with restrictive lung disease. We reviewed the postoperative course following thoracotomy in patients with diminished pulmonary function (FVC, FEV1, or TLC less than 80% predicted). Thirty-two thoracotomies were performed in 19 patients. The preoperative FVC (% predicted) was 68 +/- 3.6 with a postoperative value of 60 +/- 2.4 (P < 0.01). The preoperative FEV1 was 69 +/- 4.2 with a postoperative value of 60 +/- 3.8 (P < 0.01). Although there was a significant drop in pulmonary function tests (PFTs) following surgery, there was not a significantly greater loss when comparing patients with mild, moderate, and severe disease. When considering postoperative morbidity, there were 3 events (prolonged oxygen requirement, need for postoperative ventilation, or persistent air leak) following 20 surgeries in patients with mild preoperative respiratory dysfunction, 5 events (including one death) in the 7 patients with moderate dysfunction, and 3 events following 5 surgeries in patients with severe dysfunction. There was no correlation with a decrease in any specific PFT and the occurrence of postoperative morbidity. Our limited review suggests that aggressive surgical treatment of metastatic pulmonary disease is tolerated even in patients with severe decreases in pulmonary function.