Long‐term results of the transmanubrial osteomuscular‐sparing approach for pediatric tumors

摘要

Abstract Background The complete and safe resection of pediatric cervicothoracic tumors, mostly represented by neurogenic tumors, remains a surgical challenge because of the complex anatomy of this region. The transmanubrial osteomuscular‐sparing approach (TOSA) is an alternative to isolated or combined cervical and thoracic approaches enabling the control of supra‐aortic vessels and nerves through the thoracic inlet. Methods We retrospectively reviewed the tumor characteristics, completeness of resection, morbidity, and long‐term outcome of patients with cervicothoracic tumors removed by TOSA between 2000 and 2012 in our institution. Results Thirteen patients (7 males, 6 females) underwent surgery at a median age of 72 months (4–188) for neuroblastoma (n = 6), ganglioneuroblastoma (n = 3), rhabdoid tumor (n = 1), melanotic schwannoma (n = 1), chordoma (n = 1), and malignant peripheral nerve sheath tumor in one patient with type 1 neurofibromatosis. The median duration of the procedure was 215 minutes (110–315). Two children presented with postoperative chylothorax that resolved spontaneously. The median duration of hospitalization was 7 days (4–22). At a median follow‐up of 39 months (2–159), four patients had died of metastatic relapse (n = 2), locoregional progression (n = 1), and chemotoxicity (n = 1). The patient with melanotic schwannoma was lost to follow‐up after a local relapse at 5 months. Long‐term morbidity revealed homolateral Claude‐Bernard Horner sign and upper limb vasomotor dysfunction in disease‐free patients due to mandatory resection of the stellate ganglia. Conclusions TOSA is a valuable surgical approach for all cervicothoracic tumors with acceptable long‐term morbidity when compared with its complexity. We can therefore recommend TOSA for tumors involving the thoracic inlet.