Abstract
Aim: Video-assisted thoracoscopic surgery (VATS) has been widely used in the last decades. Nevertheless, the pros and cons of thoracoscopy vs. open surgery in pediatric oncology are still under debate. In literature, VATS has been applied for both diagnostic and ablative surgery to treat neurogenic tumors, thymic neoplasms, lung tumors and metastases, germ cell tumors, lymphoproliferative diseases, and other rare tumors. Recent reviews described excellent outcomes in pediatric oncology as well as in the treatment of adult lung cancer, with a significantly higher rate of mortality and complication in thoracotomy compared to VATS. We reviewed our experience on thoracoscopy in pediatric malignancy and compared it to the literature.Materials and Methods: This was a retrospective cohort-study of pediatric oncological patients who underwent VATS at our institution from 2007 to 2020, and a review of the recent literature on the topic.Results: A total of 43 procedures were performed on 38 oncological patients (18 males, 20 females). Median age was years 7.72 (0.35–18.6). Diagnosis: 10 neurogenic tumors, nine hematological diseases, five metastases, four lypoblastomas, three thymic pathologies, three germ cell tumors, two pleuropneumoblastomas, two myofibroblastic tumors, one myoepithelial carcinoma, one liposarcoma, and three suspected oncological mass. In three cases, a 3D model was elaborated to better plan the surgical approach. Diagnostic biopsies were 22 (51.1%), and ablative surgeries, 21 (48.9%). One neurogenic tumor was resected with the Da Vinci Robot. Median operative time was 120 min (30–420). A drain was left in place in 20 (46.5%) for a median of 4 days. Median length of hospitalization was 5 days (1–18). One case (2.3%) was converted (intraoperative bleeding). There were three post-operative complications (7.0%): one pneumonia, one pleural effusion, and one diaphragmatic paralysis (need for plication). Results were compared to recent literature, and morbidity and conversion rate were comparable to reviewed publications.Conclusion: VATS represents a valuable tool for diagnostic and therapeutic procedures in pediatric oncology. Nonetheless, it is a challenging technique that should be performed by expert surgeons on oncological and mini-invasive surgery. Three-dimensional reconstruction can optimize the pre-operative planning and guarantee a safer and more targeted treatment. Finally, the advent of robotics-assisted surgery represents a new challenge that may further implement the advantages of VATS.
Highlights
Invasive surgery (MIS), including thoracoscopy, has been widely applied in the last few decades and has become the gold standard approach for a variety of procedures for both adults and children [1,2,3].The advantages of Minimally invasive surgery (MIS) compared to the open approach are well-known, as it reduces tissue trauma, decreases post-operative pain, shortens hospital stay, and guarantees better cosmetic and long-term functional results [4, 5]
Video-assisted thoracoscopic surgery (VATS) still represents a challenge due to the limitation of working space, the smaller body size of children, reduced tactile feedback, and the lack of three-dimensional vision. As far as it concerns pediatric oncology, in the last decades, many reports and experiences have been published on the use of thoracoscopy to diagnose and resect intrathoracic neoplasms
The aim of this study is to review our experience in video-assisted thoracoscopic surgery (VATS) and robotics-assisted thoracoscopy in pediatric malignancy and to compare it to the most recent literature
Summary
Invasive surgery (MIS), including thoracoscopy, has been widely applied in the last few decades and has become the gold standard approach for a variety of procedures for both adults and children [1,2,3].The advantages of MIS compared to the open approach are well-known, as it reduces tissue trauma, decreases post-operative pain, shortens hospital stay, and guarantees better cosmetic and long-term functional results [4, 5]. Invasive surgery (MIS), including thoracoscopy, has been widely applied in the last few decades and has become the gold standard approach for a variety of procedures for both adults and children [1,2,3]. Video-assisted thoracoscopic surgery (VATS) still represents a challenge due to the limitation of working space, the smaller body size of children, reduced tactile feedback, and the lack of three-dimensional vision. As far as it concerns pediatric oncology, in the last decades, many reports and experiences have been published on the use of thoracoscopy to diagnose and resect intrathoracic neoplasms. Specific limitations are an even lower exposure in pediatric oncological cases compared to general thoracoscopic pathologies and the inability to perform digital palpation
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