Pneumonectomy for Pediatric Tumors-a Pediatric Surgical Oncology Research Collaborative Study. Ann Surg 2021 Dec 01;274(6):e605-e609
Date
03/27/2020Pubmed ID
32209902DOI
10.1097/SLA.0000000000003795Scopus ID
2-s2.0-85110461856 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
OBJECTIVE: To describe utilization and long-term outcomes of pneumonectomy in children and adolescents with cancer.
SUMMARY BACKGROUND DATA: Pneumonectomy in adults is associated with significant morbidity and mortality. Little is known about the indications and outcomes of pneumonectomy for pediatric tumors.
METHODS: 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.
RESULTS: 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).
CONCLUSION: 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.
Author List
Polites SF, Heaton TE, LaQuaglia MP, Kim ES, Barry WE, Goodhue CJ, Murphy AJ, Davidoff AM, Langham MR, Meyers RL, Short SS, Lautz TB, Glick RD, Vasudevan SA, Bence CM, Lal DR, Baertschiger RM, Emr B, Malek MM, Dasgupta RAuthors
Christina Bence MD Assistant Professor in the Surgery department at Medical College of WisconsinDave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Humans
Length of Stay
Lung Neoplasms
Myofibroma
Neoplasm Metastasis
Neoplasm Recurrence, Local
Operative Time
Osteosarcoma
Pneumonectomy
Postoperative Complications
Proportional Hazards Models
Pulmonary Blastoma
Survival Analysis