Objectives: To assess the efficacy of thoracoscopy and the outcome for children with thoracic neurogenic tumors. Methods: We performed a retrospective review of 15 European centers between 2000 and 2020 with patients who underwent thoracoscopy for a neurogenic mediastinal tumor. We assessed preoperative data, complications, and outcomes. Results were expressed with the median and range values. Results: We identified 119 patients with a median age of 4 years old (3 months–17 years). The diameter was 5.7 cm (1.1–15). INRG stage was L1n= 46, L2n= 56, MSn= 5, Mn= 12. Of 69 patients with image-defined risk factors (IDRF), 29 had only (T9–T12) locations. Twenty-three out of 34 patients with preoperative chemotherapy had an 18 mm (7–24) decrease in diameter. Seven out of 31 patients lost their IDRF after chemotherapy. Fourteen had a conversion to thoracotomy. The length of the hospital stay was 4 days (0–46). The main complications included chylothorax (n= 7) and pneumothorax (n= 5). Long-term complications included Horner’s syndrome (n= 5), back pain, and scoliosis (n= 5). Pathology was 53 neuroblastomas, 36 ganglioneuromas, and 30 ganglioneuroblastomas. Fourteen had a postoperative residue. With a median follow-up of 21 months (4–195), 9 patients had a recurrence, and 5 died of disease. Relapses were associated with tumor biology, histology, and the need for chemotherapy (p= 0.034, <0.001, and 0.015, respectively). Residues were associated with preoperative IDRF (excluding T9–T12 only) and the need for preoperative chemotherapy (p= 0.04 and 0.020). Conclusion: Our results show that thoracoscopy is safe, with good outcomes for thoracic neurogenic tumors in selected cases. Surgical outcomes are related to the IDRFs, whereas oncologic outcomes are related to tumor histology and biology.
目的：评估胸腔镜手术对儿童胸腔神经源性肿瘤的疗效及预后。方法：我们对2000年至2020年间欧洲15个医疗中心接受胸腔镜手术治疗的纵隔神经源性肿瘤患儿进行回顾性分析。评估内容包括术前资料、并发症及预后结果，数据以中位数和范围值表示。结果：共纳入119例患者，中位年龄4岁（范围3个月至17岁）。肿瘤直径中位数为5.7厘米（范围1.1-15厘米）。国际神经母细胞瘤风险分期为：L1期46例，L2期56例，MS期5例，M期12例。69例存在影像学危险因素（IDRF）的患者中，29例仅表现为T9-T12节段受累。34例接受术前化疗的患者中，23例肿瘤直径缩小18毫米（范围7-24毫米）；31例化疗后IDRF消失者7例。14例中转开胸手术。住院时间中位数为4天（范围0-46天）。主要并发症包括乳糜胸（7例）和气胸（5例）。远期并发症包括霍纳综合征（5例）、背痛及脊柱侧弯（5例）。病理类型为：神经母细胞瘤53例，神经节细胞瘤36例，神经节母细胞瘤30例。14例存在术后残留病灶。中位随访时间21个月（范围4-195个月），9例复发，5例死于疾病进展。复发与肿瘤生物学特征、组织学类型及化疗需求显著相关（p值分别为0.034、<0.001和0.015）。残留病灶与术前IDRF（排除仅T9-T12受累者）及术前化疗需求相关（p值分别为0.04和0.020）。结论：研究结果表明，胸腔镜手术在选择性病例中治疗胸腔神经源性肿瘤安全有效，手术预后与IDRF相关，而肿瘤学预后则与组织学类型和生物学特征密切相关。
Thoracoscopy for Pediatric Thoracic Neurogenic Tumors—A European Multi-Center Study
肿瘤(癌症)患者之家