Thoracoscopic resection of computed tomography-localized lung nodules in children

J Pediatr Surg. 2013 Apr;48(4):750-6. doi: 10.1016/j.jpedsurg.2012.09.051.

Abstract

Purpose: Detection and treatment of small lung nodules are important in managing pediatric cancer. We studied the effectiveness of preoperative localization of pulmonary nodules by CT-guided needle hook wire placement followed by thoracoscopic resection in children with cancer.

Methods: We reviewed records of patients who underwent thoracoscopic resection of lung nodules localized preoperatively with CT-guided needle and hook wire placement at our hospital between March 1999 and April 2010 for nodule characteristics and outcomes of procedure.

Results: Thirty-seven patients (median age, 14years) with osteosarcoma or other cancers underwent thoracoscopic resection of needle-localized lung nodules. Lesion (median nodule size, 4mm) location was left lung (n=11), right lung (n=19), and bilateral (n=7). The procedure was successful in 36 (97.3%) patients. Five patients had a pneumothorax after localization but none required chest tube placement before thoracoscopy. All patients underwent thoracoscopy, but 4 required conversion to open thoracotomy. During thoracoscopic inspection, the hook wire slipped out of the lesion in 6 patients, of whom 1 needed thoracotomy to locate nodule. Lesions (malignant in 13 patients) were removed in all patients. Five patients with benign lesions had recurrent malignant lung nodules.

Conclusions: Thoracoscopic resection of preoperatively localized small lung nodules is a safe and effective procedure in children.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / surgery*
  • Male
  • Neoplasm Recurrence, Local
  • Postoperative Complications
  • Radiography, Interventional*
  • Solitary Pulmonary Nodule / diagnostic imaging*
  • Solitary Pulmonary Nodule / surgery*
  • Thoracoscopy / methods*
  • Tomography, X-Ray Computed*
  • Treatment Outcome
  • Young Adult