Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Ann Surg. 2021 Dec 1;274(6):e605-e609. doi: 10.1097/SLA.0000000000003795.
To describe utilization and long-term outcomes of pneumonectomy in children and adolescents with cancer.
Pneumonectomy in adults is associated with significant morbidity and mortality. Little is known about the indications and outcomes of pneumonectomy for pediatric tumors.
The Pediatric Surgical Oncology Research Collaborative (PSORC) identified pediatric patients <21 years of age who underwent pneumonectomy from 1990 to 2017 for primary or metastatic tumors at 12 institutions. Clinical information was collected; outcomes included operative complications, long-term function, recurrence, and survival. Univariate log rank, and multivariable Cox analyses determined factors associated with survival.
Thirty-eight patients (mean 12 ± 6 yrs) were identified; median (IQR) follow-up was 19 (5-38) months. Twenty-six patients (68%) underwent pneumonectomy for primary tumors and 12 (32%) for metastases. The most frequent histologies were osteosarcoma (n = 6), inflammatory myofibroblastic tumors (IMT; n = 6), and pleuropulmonary blastoma (n = 5). Median postoperative ventilator days were 0 (0-1), intensive care 2 (1-3), and hospital 8 (5-16). Early postoperative complications occurred in 10 patients including 1 death. Of 25 (66%) patients alive at 1 year, 15 reported return to preoperative pulmonary status. All IMT patients survived while all osteosarcoma patients died during follow-up. On multivariable analysis, metastatic indications were associated with nonsurvival (HR = 3.37, P = 0.045).
This is the largest review of children who underwent pneumonectomy for cancer. There is decreased procedure-related morbidity and mortality than reported for adults. Survival is worse with preoperative metastatic disease, especially osteosarcoma.
描述儿童和青少年癌症患者行肺切除术的利用情况和长期结果。
成人肺切除术与显著的发病率和死亡率相关。对于儿童肿瘤患者肺切除术的适应证和结果知之甚少。
儿科外科肿瘤研究协作组（PSORC）确定了 1990 年至 2017 年期间在 12 个机构因原发性或转移性肿瘤而在 21 岁以下儿童中接受肺切除术的患者。收集临床信息；结果包括手术并发症、长期功能、复发和生存。单变量对数秩和多变量 Cox 分析确定与生存相关的因素。
确定了 38 名患者（平均年龄 12±6 岁）；中位（IQR）随访时间为 19（5-38）个月。26 名患者（68%）因原发性肿瘤和 12 名（32%）因转移灶而行肺切除术。最常见的组织学类型为骨肉瘤（n=6）、炎性肌纤维母细胞瘤（IMT；n=6）和胸膜肺胚细胞瘤（n=5）。术后中位呼吸机使用天数为 0（0-1）天，重症监护 2（1-3）天，住院 8（5-16）天。10 例患者发生早期术后并发症，包括 1 例死亡。在 1 年时存活的 25 名（66%）患者中，有 15 名报告恢复术前肺功能状态。所有 IMT 患者均存活，而所有骨肉瘤患者在随访期间均死亡。多变量分析显示，转移性适应证与非生存相关（HR=3.37，P=0.045）。
这是最大的儿童癌症肺切除术综述。与成人报道的结果相比，该手术与较低的与手术相关的发病率和死亡率相关。术前转移性疾病，尤其是骨肉瘤，生存率更差。
