title: Analysis of sternotomy as treatment option for the resection of bilateral pulmonary metastases in pediatric solid tumors.
abstract: BACKGROUND
  Radical surgical resection of metastases is an important prognostic factor for survival of patients suffering from solid pediatric tumors. The aim of this study is to evaluate the efficacy of median sternotomy as treatment option for the resection of multiple bilateral lung metastases in children with different tumor entities. Furthermore, the sensitivity of preoperative imaging (CT) was assessed by intraoperative findings.
  
  
  METHODS
  Between 2002 and 2007, 13 children (4 with sarcoma, 4 with nephroblastoma, 5 with hepatoblastoma) underwent median sternotomy for resection of bilateral lung metastases after R0-resection of the primary tumor. In 6/13 cases, the sternotomy was combined with the primary tumor resection.
  
  
  RESULTS
  Median patient age at the first operation was 5 years (range: 11 months to 17 years). The median total number of resected metastases per operation was 9 and ranged from 0 to 65. In 13/16 operations, the intraoperative number of metastases did not agree with the preoperative radiological work-up. Median hospital stay was 14 days (range from 9 to 36 days). Ten out of 13 children are alive after a median follow-up of 13 months (range from 6 to 66 months).
  
  
  CONCLUSIONS
  Median sternotomy is an adequate treatment modality for the resection of bilateral pulmonary metastases as a one-stage procedure. The combination of primary tumor resection with sternotomy should be considered as a treatment option. Complete resection of metastases of solid pediatric tumors should be aimed for in order to increase the survival of these patients.
authors.affiliation: Department of Pediatric Surgery, University Children's Hospital, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany. joerg.fuchs@med.uni-tuebingen.de
authors.forename: Jörg
authors.initials: J
authors.lastname: Fuchs
authors.forename: Guido
authors.initials: G
authors.lastname: Seitz
authors.forename: Verena
authors.initials: V
authors.lastname: Ellerkamp
authors.forename: Klaus
authors.initials: K
authors.lastname: Dietz
authors.forename: Axel
authors.initials: A
authors.lastname: Bosk
authors.forename: Ingo
authors.initials: I
authors.lastname: Müller
authors.forename: Steven W
authors.initials: SW
authors.lastname: Warmann
authors.forename: Jürgen F
authors.initials: JF
authors.lastname: Schäfer
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000401:mortality / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005354:Fibrosarcoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D018197:Hepatoblastoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D012516:Osteosarcoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000401:mortality / Q000556:secondary* / Q000601:surgery