S. J. Commander1, M. Goss1, Y. Shi1, R. Flores2, S. Vasudevan1 1Baylor College Of Medicine,Pediatric Surgery,Houston, TX, USA 2Baylor College Of Medicine,Hematology/ Oncology,Houston, TX, USA
Introduction: Metastasectomy of lung nodules is an accepted surgical therapy for many pediatric malignancies after local control of the primary tumor has been achieved. For bilateral lung nodules staged, sequential thoracotomies have been the traditional approach to clearing metastatic disease. Our institution has focused on reducing the number of anesthetics by combining procedures when possible and providing a dedicated pain management service to our surgical patients; therefore, we began performing bilateral, simultaneous, muscle-sparing thoracotomies for metastatectomy.
Methods: The clinical data of 12 children (< 18 years old) with pediatric solid tumors and bilateral lung metastases who underwent simultaneous or staged bilateral thoracotomies for metastatectomy from January 2011 to August 2016 were retrospectively collected at a single institution. Length of stay and days requiring thoracic epidural were summated for the two surgeries in the staged thoracotomy group.
Results: Seven pediatric patients who underwent simultaneous bilateral thoracotomies (BT) and five who underwent staged thoracotomies (ST) for metastatic pulmonary disease were identified. Eight patients had osteosarcoma, two hepatoblastoma, and one synovial sarcoma. A muscle-sparing technique was utilized for all thoracotomies performed in both groups. The median operative times for the BT group was 315 minutes versus the combined median operative time of 525 minutes for the ST group. Median length of hospital admission was 8 days for BT and 14 days for ST, with thoracic epidural in place for a median of 5 days post-operatively for BT and 7 days for ST. Number of lung nodules resected on each patient in the BT group ranged from 5 to 33 (median = 8), while the ST group ranged from 5 to 35 (median = 16). One patient in each group experienced an intra-operative complication, and one patient in the BT group presented with a post-operative complication. None of the complications had long-term effects and only one patient in the BT group required a return to the operating room to drain bilateral wound hematoma/seroma.
Conclusion: Simultaneous bilateral muscle-sparing thoracotomies should be considered as an effective and well tolerated approach in patients with bilateral pulmonary metastases who require metastatectomy.