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Video-assisted thoracic surgery (VATS) for children with pulmonary metastases from osteosarcoma
J C Gilbert1, D M Powell, G E Hartman
1Department of Surgery, Children's National Medical Center, Washington, DC 20010, USA.
Background:
Video-assisted thoracic surgery (VATS) may complement open thoracotomy in children with osteosarcoma requiring pulmonary metastasectomy.
Methods:
The records of children with metastatic pulmonary osteosarcoma considered for initial VATS intervention (n = 9) were reviewed.
Results:
Two children did not have VATS exploration: one child with multiple bilateral nodules and another child with a deep parenchymal nodule. VATS provided diagnostic biopsy material in all cases when used (n = 7). Two children had benign inflammatory lesions; four children had VATS-directed wedge resections of solitary malignant lesions; and one child had VATS biopsy of diffuse parenchymal and pleural pulmonary disease not amenable to resection. The mean operative time and hospital length of stay were 1.78 +/- 0.54 h and 3.5 +/- 1.8 days, respectively. There were two complications of VATS: bleeding in a child, requiring a transfusion, and a latent pneumothorax in a patient after removal of the chest tube.
Conclusion:
VATS is safe, serves as an excellent diagnostic modality, complements the open thoracotomy, and may enable the surgeon to avoid more extensive procedures in selected cases.