Trapdoor anterior thoracotomy for cervicothoracic and apical thoracic neuroblastoma in children
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ORIGINAL ARTICLE
Trapdoor anterior thoracotomy for cervicothoracic and apical thoracic neuroblastoma in children Chan Hon Chui1 · Agasthian Thirugnanam2 Accepted: 4 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Cervicothoracic and apical thoracic neuroblastoma pose unique surgical challenges. We report our experience with the trapdoor anterior thoracotomy (TAT) approach to overcome these difficulties. Methods Retrospective review of our centre’s neuroblastoma database was conducted. Patients who underwent TAT at our centre were included, their demographic data and clinical reports were analyzed. Results A total of 21 patients underwent TAT for neuroblastoma, mean age at surgery of 3.5 (0.3–7.9) years, male to female ratio was 11:10. Fifteen patients had cervicothoracic tumors while 6 had apical thoracic tumors. All except 2 were primary tumors. They were stage M (n = 12), MS (n = 1), and L2 (n = 8). At pre-operative assessment, 19 patients had image-defined risk factor (IDRF), including dual compartmental involvement (n = 15), trachea/bronchus compression (n = 4), encasement of carotid (n = 5), subclavian (n = 11), and vertebral arteries (n = 6). Four underwent upfront surgery while 17 received preoperative chemotherapy of 2–8 (mean 3.9) cycles. All patients accomplished gross total resection. None had MYCN amplification. The postoperative complications included Horner’s syndrome (n = 21), Klumpke’s palsy (n = 1), winged scapula (n = 1), phrenic nerve palsy (n = 1), and bronchomalacia (n = 2). Conclusion Gross total resection of cervicothoracic and apical thoracic neuroblastoma can be accomplished by TAT with minimal morbidity. Keywords Cervicothoracic neuroblastoma · Apical thoracic neuroblastoma · Surgery · Trapdoor thoracotomy
Introduction Neuroblastoma in the cervicothoracic region is rare [1, 2]. According to the nomenclature of sympathetic nervous system in Terminologia Anatomica, it arises from the paravertebral cervicothoracic ganglia, and commonly associates with concurrent tumor involving the periarterial sympathetic pathways in the superior mediastinum [3]. As such, these tumors often encase the subclavian, vertebral and/or carotid arteries. The surgical management is often challenging because of its unique location, limited access and risks associated with vascular encasement. Similar to * Chan Hon Chui [email protected] 1
Surgery Centre for Children, Mount Elizabeth Medical Centre, #10‑08 Mount Elizabeth Medical Centre, 3 Mount Elizabeth, Singapore 228510, Singapore
Agasthian Thoracic Surgery, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, Singapore 228510, Singapore
2
neuroblastoma at other sites, adequate surgical resection of ≥90% is preferred [4]. Neuroblastoma confined to the apical thorax, defined as those that originate from the paravertebral thoracic ganglia at the upper thoracic levels without extension to the cervical region, poses similar challenges. It bears noting that apical thoracic neuroblastoma often associat
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