Jacqueline Tsai1, Peter Mattei. 1. General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Abstract
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.
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.