Surgical approach to pediatric mediastinal masses based on imaging characteristics.

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  • Additional Information
    • Source:
      Publisher: Springer International Country of Publication: Germany NLM ID: 8609169 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1437-9813 (Electronic) Linking ISSN: 01790358 NLM ISO Abbreviation: Pediatr Surg Int Subsets: MEDLINE
    • Publication Information:
      Original Publication: Berlin : Springer International, c1986-
    • Subject Terms:
      Mediastinal Neoplasms*/diagnostic imaging ; Mediastinal Neoplasms*/surgery ; Thoracotomy*; Child ; Humans ; Retrospective Studies ; Thoracic Surgery, Video-Assisted/methods ; Treatment Outcome
    • Abstract:
      Background: Pediatric mediastinal masses may be resected using an open or video-assisted thoracoscopic surgery (VATS) approach. We sought to define the preoperative imaging findings predicting amenability to VATS.
      Methods: This multicenter retrospective study of pediatric patients undergoing either VATS or open surgical mediastinal mass resection between 2008 and 2018 evaluated the preoperative imaging descriptors associated with VATS. Postoperative endpoints included length of stay (LOS), 30-day readmission, 90-day mortality and complication rates.
      Results: Mediastinal mass resection was performed in 33 patients. Median tumor size was 6 cm, and 51.5% had anterior mediastinal tumors. The 23 (69.7%) patients who underwent VATS were significantly older (144 months vs 32, P = 0.01) and larger (33.6 kg vs 13.8 P = 0.03). Preoperative imaging characteristics in VATS included "well circumscribed", "smooth margins" and "cystic", while the open surgery group were "heterogeneous" and "coarse calcification". The open group had more germ cell tumors (60.0% vs 13.0%, P = 0.16) but no difference in malignancy. VATS patients had shorter LOS (2 days vs 6.5, P = 0.24). Readmission, complication and mortality rates were similar.
      Conclusions: Pediatric patients with apparent malignancy frequently underwent open resection compared with the thoracoscopic group, although final malignant pathology was similar. Equivalent outcomes and shorter LOS should favor a minimally invasive approach.
      Level of Evidence: Level III.
      (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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    • Contributed Indexing:
      Keywords: Image-defined risk factors; Mediastinal mass; Preoperative imaging; Thoracoscopic; VATS
    • Publication Date:
      Date Created: 20220706 Date Completed: 20220809 Latest Revision: 20220809
    • Publication Date:
      20240829
    • Accession Number:
      10.1007/s00383-022-05166-3
    • Accession Number:
      35794495