Pneumonectomy for Pediatric Tumors—a Pediatric Surgical Oncology Research Collaborative Study. Issue 6 (December 2021)

• Record Type: Journal Article
• Authors: Polites, Stephanie F.; Heaton, Todd E.; LaQuaglia, Michael P.; Kim, Eugene S.; Barry, Wesley E.; Goodhue, Catherine J.; Murphy, Andrew J.; Davidoff, Andrew M.; Langham, Max R.; Meyers, Rebecka L.; Short, Scott S.; Lautz, Timothy B.; Glick, Richard D.; Vasudevan, Sanjeev A.; Bence, Christina M.; Lal, Dave R.; Baertschiger, Reto M.; Emr, Bryanna; Malek, Marcus M.; Dasgupta, Roshni
• Is Part Of: Annals of surgery. Volume 274:Issue 6(2021)
• Publication Date: 2021-12
• Subjects: inflammatory myofibroblastic tumor -- pediatric -- pleuropulmonary blastoma -- pneumonectomy -- sarcoma -- surgical oncology; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000003795
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : 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.