Pulmonary metastases in children: the place of surgery. A study of 134 patients.

A series of 134 children, less than 15 years of age at the time of diagnosis of tumor, treated by one oncology group and one surgeon, have been submitted to thoracotomy for pulmonary metastatic disease between 1961 and 1976. Fifteen had a thoracic exploration only because of the extent of disease and died. Three had a nodule excised which proved to be nonmetastatic at histology and are alive. One hundred and sixteen underwent 152 excisional procedures with 2 operative deaths, 1 postpneumonectomy empyema, 2 transient postoperative complications, and 4 local relapses. Fifty-one are alive 4 to 15 years after the last surgical procedure. The results are best when a single (or a few) metastasis is removed as a primary treatment followed by chemotherapy and/or radiotherapy when indicated. Results are better in Wilms' tumors than in other tumors. Radiotherapy which can lead to long term pulmonary sequelae can be avoided in half of the patients (26/51). Thoracotomy is a safe and simple procedure in children, giving rewarding results when the indications of excision, among the different means of treatment, are carefully chosen.