Fuchs Jörg, Seitz Guido, Ellerkamp Verena, Dietz Klaus, Bosk Axel, Müller Ingo, Warmann Steven W, Schäfer Jürgen F
Department of Pediatric Surgery, University Children's Hospital, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
Surg Oncol. 2008 Dec;17(4):323-30. doi: 10.1016/j.suronc.2008.05.004. Epub 2008 Jun 30.
Radical surgical resection of metastases is an important prognostic factor for survival of patients suffering from solid pediatric tumors. The aim of this study is to evaluate the efficacy of median sternotomy as treatment option for the resection of multiple bilateral lung metastases in children with different tumor entities. Furthermore, the sensitivity of preoperative imaging (CT) was assessed by intraoperative findings.
Between 2002 and 2007, 13 children (4 with sarcoma, 4 with nephroblastoma, 5 with hepatoblastoma) underwent median sternotomy for resection of bilateral lung metastases after R0-resection of the primary tumor. In 6/13 cases, the sternotomy was combined with the primary tumor resection.
Median patient age at the first operation was 5 years (range: 11 months to 17 years). The median total number of resected metastases per operation was 9 and ranged from 0 to 65. In 13/16 operations, the intraoperative number of metastases did not agree with the preoperative radiological work-up. Median hospital stay was 14 days (range from 9 to 36 days). Ten out of 13 children are alive after a median follow-up of 13 months (range from 6 to 66 months).
Median sternotomy is an adequate treatment modality for the resection of bilateral pulmonary metastases as a one-stage procedure. The combination of primary tumor resection with sternotomy should be considered as a treatment option. Complete resection of metastases of solid pediatric tumors should be aimed for in order to increase the survival of these patients.
根治性手术切除转移灶是实体儿科肿瘤患者生存的重要预后因素。本研究的目的是评估正中胸骨切开术作为不同肿瘤类型儿童双侧多发肺转移灶切除的治疗选择的疗效。此外，通过术中发现评估术前影像学检查（CT）的敏感性。
2002年至2007年间，13例儿童（4例肉瘤、4例肾母细胞瘤、5例肝母细胞瘤）在原发肿瘤R0切除术后接受正中胸骨切开术以切除双侧肺转移灶。13例中有6例，胸骨切开术与原发肿瘤切除术联合进行。
首次手术时患者中位年龄为5岁（范围：11个月至17岁）。每次手术切除转移灶的中位总数为9个，范围为0至65个。在16次手术中的13次，术中转移灶数量与术前影像学检查结果不一致。中位住院时间为14天（范围9至36天）。13例儿童中有10例在中位随访13个月（范围6至66个月）后存活。
正中胸骨切开术作为一期手术是切除双侧肺转移灶的一种合适治疗方式。原发肿瘤切除与胸骨切开术的联合应被视为一种治疗选择。为提高这些患者的生存率，应致力于完全切除实体儿科肿瘤的转移灶。
