A single-center study of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors

Abstract

Objective: To study the feasibility, safety, and efficacy of thoracoscopic surgery in the treatment of pediatric mediastinal neurogenic tumors, and summarize the treatment experiences and surgical skills.

Methods: A single-center retrospective analysis of 37 patients with pediatric mediastinal neurogenic tumors was conducted. Clinical charactersistics and postoperative complications were all analyzed.

Results: All the operations were successfully completed. There was no statistically significant difference in tumor diameter between the two groups (p > 0.05). The open surgery group had an average operation time of 96.5 ± 32.38 min, while the thoracoscopic surgery group had an average operation time of 78.3 ± 24.51 min (p < 0.05). The thoracoscopic surgery group had significantly lower intraoperative blood loss than the open surgery group (p < 0.05). In addition, the duration of the postoperative thoracic drainage tube was 5.43 ± 0.76 days in the open surgery group, which was longer than the 2.38 ± 0.87 days in the thoracoscopic surgery group (p < 0.05). Furthermore, the postoperative length of hospital stay was an average of 10.23 ± 1.43 days for the open surgery group, longer than for the thoracoscopic surgery group (4.36 ± 0.87 days) (p < 0.05).

Conclusions: Thoracoscopic surgery has several advantages in the treatment of pediatric mediastinal neurogenic tumors and is worthy of clinical popularization and application. For giant mediastinal malignant neurogenic tumors, puncture biopsy and adjuvant chemotherapy can be performed before surgery to lessen the tumor volume and enlarge the operation space, which would reduce bleeding and complications.

Keywords: children neurogenic tumor; mediastinal neurogenic tumors; thoracoscope.

FIGURE 1

(a) Intraoperative exploration of a tumor located in the upper mediastinum. (b) Incision mediastinal pleura, free tumor. (c) Exact hemostasis, complete resection. (d) Open surgery for giant mediastinal tumor cannot be resected by thoracoscopic. (e) Resection of mediastinal tumor in blocks

FIGURE 2

(a) Yellow portion of the mediastinal neurogenic mass clearly seen adjacent to the surrounding tissue. (b) Three‐dimensional reconstruction of neuroblastoma in one case of open surgery in this study shows large tumors

FIGURE 3

(a) Tumor/chest index ≤0.5. (b) Tumor/chest index ≥0.5. (c) The tumor is large and close to the spinal and macrovascular. (d) Suspended the tumor and exposed the gap. (e) Preoperative computerized tomography showing that the tumor is large and cannot be removed by endoscopy. Chemotherapy was started before surgery. (f) Piecemeal resection of the giant tumor by open surgery