Resection of neurogenic tumors in children: Is thoracoscopy superior to thoracotomy?
Resection of neurogenic tumors in children: Is thoracoscopy superior to thoracotomy?
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DOI：
10.1016/j.jamcollsurg.2006.07.022
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发表时间：
2006-11-01
影响因子：
5.2
通讯作者：
Karrer, Frederick M.
中科院分区：
文献类型：
--
作者：
Petty, John K.;Bensard, Denis D.;Karrer, Frederick M.
背景：实体瘤的微创切除术存在争议，因为担心切除不充分和局部复发。胸腔镜在小儿纵隔肿瘤的诊断中已有一定的应用，但其在肿瘤切除中的作用尚未得到证实。本研究的目的是比较胸腔镜和开放的方法切除胸部神经源性肿瘤的children.Study Design：肿瘤登记的区域儿童医院进行查询，以确定患者接受切除神经源性肿瘤超过6年的时间。胸腔镜组和开放组进行了比较人口，手术，肿瘤学，和outcomes characteristics.RESULTS：17名儿童进行切除纵隔神经源性肿瘤（10胸腔镜切除术，7开放切除术）。平均年龄为4.7岁（范围6个月至12岁）。胸腔镜组和开放组在手术时间或失血量方面没有差异。两组的肿瘤大小（5.2 +/- 2.2 cm vs 5.7 +/- 2.6 cm）、组织学、手术切缘和分期相当。胸腔镜切除术后住院时间较短（1.9 +/- 0.7天vs 4.1 +/- 2.5天，p < 0.05）。无局部复发。每组各有1例患者发生远处转移。10例恶性肿瘤患儿中有8例在平均25个月的随访（范围3至80个月）中保持无病状态。结论：胸腔镜下神经源性肿瘤切除术与开放性切除术相比，在这一初步系列中取得了相似的局部控制和无病生存率。这些结果伴随着较短的住院时间。这些结果表明，胸腔镜下切除儿童神经源性肿瘤可能比开放切除术具有优势，应在大型合作试验的背景下进行研究。
BACKGROUND: Minimally invasive resection of solid tumors is controversial because of concerns of inadequate resection and local recurrence. Thoracoscopy has been used in the diagnosis of mediastinal tumors in children, but its role in resection is unproved. The purpose of this study was to compare thoracoscopic and open approaches to the resection of thoracic neurogenic tumors in children.STUDY DESIGN: The tumor registry of a regional children's hospital was queried to identify patients who underwent resection of neurogenic tumors over a 6-year period. Thoracoscopic and open groups were compared for demographic, operative, oncologic, and outcomes characteristics.RESULTS: Seventeen children underwent resection of mediastinal neurogenic tumors (10 thoracoscopic resections, 7 open resections). Mean age was 4.7 years (range 6 months to 12 years). The thoracoscopic and open groups showed no difference in operative time or blood loss. Tumors in the two groups were comparable in size (5.2 +/- 2.2 cm versus 5.7 +/- 2.6 cm), histology, surgical margin, and stage. Hospital stay was shorter after thoracoscopic resection (1.9 +/- 0.7 days versus 4.1 +/- 2.5 days, p < 0.05). There were no regional recurrences. Distant metastases developed in one patient in each group. Eight of 10 children with malignant tumors remain disease-free at an average of 25 months of followup (range 3 to 80 months).CONCLUSIONS: Thoracoscopic resection of neurogenic tumors achieved similar local control and disease-free survival when compared with open resection in this preliminary series. These results were accompanied by a shorter hospital stay. These findings suggest that thoracoscopic resection of neurogenic tumors in children may offer advantages to open resection and should be studied in the context of a large, cooperative trial.