Ahmed Gehad, Hegazy Mohammed M, Raafat Tarek, Hafez Hanafy, Fadel Sayed, Elshafiey Maged
Department of Surgery, Faculty of Medicine, Helwan University, Egypt; Surgical Oncology Department, Children's Cancer Hospital (CCHE), Egypt.
Anesthesia Department, CCHE, Egypt; Department of Anesthesia, National Cancer Institute, Cairo University, Egypt.
J Egypt Natl Canc Inst. 2017 Sep;29(3):147-153. doi: 10.1016/j.jnci.2017.08.001. Epub 2017 Aug 31.
Pediatric superior mediastinal tumors are a heterogeneous group of tumors with marked variation in pathology and extension. We reviewed our experience with different surgical approaches to tumors originating from or extending to superior mediastinum in pediatrics.
The medical records of all patients who had undergone resection for superior mediastinal tumors in Children's Cancer Hospital - Egypt, between January 2008 to December 2015, were reviewed for demographic data, clinico-pathological features, radiologic findings, operative techniques and outcome.
The study included 20 patients. Diagnosis included: germ cell tumors (n=8), neuroblastoma (n=4), soft tissue sarcoma (n=3), thymolipoma (n=2), infantile fibromatosis (n=1), calcifying fibrous tumor (n=1), and thymic carcinoma (n=1). Tumor extension was divided into tumors extending unilaterally to one hemithorax (n=9), tumors extending bilaterally to both hemithoraces (n=4), and cervico thoracic junction tumors (n=7). Extended lateral thoracotomy was used in 8 patients. Other approaches included trapdoor (n=5), clamshell (n=4), cervical approach (n=2) and double level lateral thoracotomy (n=1). There was no perioperative mortality, and postoperative morbidity was 20%. At the end of December 2016, 15 patients were alive free of disease, 5 patients developed local and/ or distant relapse.
Pediatric superior mediastinal tumors could be divided into 3 groups according to tumor extension. Each group has an optimum surgical approach that achieves the best exposure for adequate resection. However, further research is needed to confirm the conclusion as this was a descriptive study and the sample size was too small for valid statistical analysis.
小儿纵隔肿瘤是一组异质性肿瘤，在病理学和范围方面有显著差异。我们回顾了小儿起源于或延伸至纵隔肿瘤的不同手术方法的经验。
对2008年1月至2015年12月在埃及儿童癌症医院接受纵隔肿瘤切除术的所有患者的病历进行回顾，以获取人口统计学数据、临床病理特征、影像学检查结果、手术技术及预后情况。
该研究纳入20例患者。诊断包括：生殖细胞瘤（n = 8）、神经母细胞瘤（n = 4）、软组织肉瘤（n = 3）、胸腺脂肪瘤（n = 2）、婴儿纤维瘤病（n = 1）、钙化性纤维瘤（n = 1）和胸腺癌（n = 1）。肿瘤范围分为单侧延伸至一侧胸腔的肿瘤（n = 9）、双侧延伸至两侧胸腔的肿瘤（n = 4）和颈胸交界区肿瘤（n = 7）。8例患者采用了扩大侧开胸术。其他手术方法包括掀盖式手术（n = 5）、蚌式手术（n = 4）、颈部手术入路（n = 2）和双水平侧开胸术（n = 1）。无围手术期死亡，术后发病率为20%。截至2016年12月底，15例患者无病存活，5例患者出现局部和/或远处复发。
小儿纵隔肿瘤可根据肿瘤范围分为3组。每组都有最佳的手术方法，能获得充分切除所需的最佳暴露。然而，由于本研究为描述性研究且样本量过小无法进行有效的统计学分析，因此需要进一步研究以证实该结论。
