Surgical approach to pediatric mediastinal masses based on imaging characteristics
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In brief
In brief
Multicenter study of 33 pediatric patients identifies preoperative imaging features predicting successful VATS for mediastinal masses. Well-circumscribed, smooth-margined, cystic lesions were amenable to thoracoscopic approach with shorter hospital stays versus open surgery, despite similar malignancy rates between groups.
Written by the GCMD Library team from the article.
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.