title: Resection of neurogenic tumors in children: is thoracoscopy superior to thoracotomy?
abstract: BACKGROUND
  Minimally invasive resection of solid tumors is controversial because of concerns of inadequate resection and local recurrence. Thoracoscopy has been used in the diagnosis of mediastinal tumors in children, but its role in resection is unproved. The purpose of this study was to compare thoracoscopic and open approaches to the resection of thoracic neurogenic tumors in children.
  
  
  METHODS
  The tumor registry of a regional children's hospital was queried to identify patients who underwent resection of neurogenic tumors over a 6-year period. Thoracoscopic and open groups were compared for demographic, operative, oncologic, and outcomes characteristics.
  
  
  RESULTS
  Seventeen children underwent resection of mediastinal neurogenic tumors (10 thoracoscopic resections, 7 open resections). Mean age was 4.7 years (range 6 months to 12 years). The thoracoscopic and open groups showed no difference in operative time or blood loss. Tumors in the two groups were comparable in size (5.2+/-2.2 cm versus 5.7+/-2.6 cm), histology, surgical margin, and stage. Hospital stay was shorter after thoracoscopic resection (1.9+/-0.7 days versus 4.1+/-2.5 days, p<0.05). There were no regional recurrences. Distant metastases developed in one patient in each group. Eight of 10 children with malignant tumors remain disease-free at an average of 25 months of followup (range 3 to 80 months).
  
  
  CONCLUSIONS
  Thoracoscopic resection of neurogenic tumors achieved similar local control and disease-free survival when compared with open resection in this preliminary series. These results were accompanied by a shorter hospital stay. These findings suggest that thoracoscopic resection of neurogenic tumors in children may offer advantages to open resection and should be studied in the context of a large, cooperative trial.
authors.affiliation: Department of Pediatric Surgery, The Children's Hospital/University of Colorado, Denver, CO 80218, USA.
authors.forename: John K
authors.initials: JK
authors.lastname: Petty
authors.forename: Denis D
authors.initials: DD
authors.lastname: Bensard
authors.forename: David A
authors.initials: DA
authors.lastname: Partrick
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hendrickson
authors.forename: Edythe A
authors.initials: EA
authors.lastname: Albano
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Karrer
mesh_terms: D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D013906:Thoracoscopy; D013908:Thoracotomy