title: Prognostic risk factors for the development of scoliosis after chest wall resection for malignant tumors in children.
abstract: BACKGROUND
  Surgical resection of a malignant tumor of the chest wall in children may result in the development of progressive scoliosis. The aim of this study was to identify the risk factors associated with scoliosis following resection of a tumor of the chest wall and to evaluate the prevalence and characteristics of the scoliosis.
  
  
  METHODS
  Forty children who underwent resection of a malignant tumor of the chest wall from 1984 to 2005 were included in a multicenter, retrospective cohort study. The mean age of the patients at the time of surgery was 9.8 years (range, 0.2 to nineteen years). Resections were classified with the use of the following scheme: the number of resected ribs was noted in Roman numerals, and the level of the resection was identified by dividing the thorax into three sectors (A [anterior], B [lateral], and C [posterior]) in the horizontal plane. One to five ribs (mean, 2.3 ribs) were resected. Patients with scoliosis were compared with patients who did not have scoliosis through the use of univariate and multivariate analyses. The mean duration of follow-up was 8.5 years (range, three to twenty-three years).
  
  
  RESULTS
  Patients who had a tumor resection during a rapid-growth period (patient age of less than six years or between twelve and fifteen years) had a 5.8 times higher risk of scoliosis. The resection of three or more ribs in the posterior sector (C) was the primary risk factor for scoliosis, with an odds ratio of 18.9. Seventeen (43%) of the children developed scoliosis, which was convex toward the resection side without vertebral rotation in all of them.
  
  
  CONCLUSIONS
  The risk of scoliosis following the resection of a primary malignant tumor of the chest wall in children was shown to be higher when resection was performed during a rapid-growth period and when the resection involved three or more ribs in the posterior sector.
authors.affiliation: Hôpital Femme Mère Enfant, Department of Pediatric Surgery, 59 Bd Pinel, 69500 Bron, France. E-mail address for A. Scalabre: aurelien.scalabre@chu-lyon.fr. E-mail address for F. Hameury: frederic.hameury@chu-lyon.fr. E-mail address for V. Cunin: vincent.c.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Scalabre
authors.affiliation: Clinique du Val d'Ouest, Department of Pediatric Surgery, 39 Chemin de la Vernique, 69130 Ecully, France. E-mail address: rpparot@hotmail.fr.
authors.forename: Roger
authors.initials: R
authors.lastname: Parot
authors.affiliation: Hôpital Femme Mère Enfant, Department of Pediatric Surgery, 59 Bd Pinel, 69500 Bron, France. E-mail address for A. Scalabre: aurelien.scalabre@chu-lyon.fr. E-mail address for F. Hameury: frederic.hameury@chu-lyon.fr. E-mail address for V. Cunin: vincent.c.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Hameury
authors.affiliation: Hôpital Femme Mère Enfant, Department of Pediatric Surgery, 59 Bd Pinel, 69500 Bron, France. E-mail address for A. Scalabre: aurelien.scalabre@chu-lyon.fr. E-mail address for F. Hameury: frederic.hameury@chu-lyon.fr. E-mail address for V. Cunin: vincent.c.
authors.forename: Vincent
authors.initials: V
authors.lastname: Cunin
authors.affiliation: Hôpital de la Timone, Department of Pediatric Orthopedic Surgery, 264 Rue Saint Pierre, 13385 Marseille, France. E-mail address: jean-luc.jouve@ap-hm.fr.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Jouve
authors.affiliation: Hôpital Femme Mère Enfant, Department of Pediatric Surgery, 59 Bd Pinel, 69500 Bron, France. E-mail address for A. Scalabre: aurelien.scalabre@chu-lyon.fr. E-mail address for F. Hameury: frederic.hameury@chu-lyon.fr. E-mail address for V. Cunin: vincent.c.
authors.forename: Franck
authors.initials: F
authors.lastname: Chotel
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D018570:Risk Assessment; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D017678:Sex Distribution; D013899:Thoracic Neoplasms / Q000473:pathology / Q000601:surgery*; D035441:Thoracic Wall / Q000473:pathology / Q000601:surgery*; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult