title: Bilateral anterior sternothoracotomy (clamshell incision): a suitable alternative for bilateral lung sarcoma metastasis in children.
abstract: BACKGROUND
  The aim of our study was to assess the postoperative course of bilateral anterior sternothoracotomy (BAT) in children with sarcoma metastases, in a curative care perspective.
  
  
  METHODS
  We reviewed the records of seven patients younger than 18 years old, who underwent surgical procedures for sarcoma metastasis to the lung between 2000 and 2012. We compared the postoperative course of the BAT group with that of patients who underwent unilateral posterolateral thoracotomies (PLTs) for the same etiology.
  
  
  RESULTS
  Of 17 surgical procedures, there were seven BAT and 10 unilateral PLT. Mean ages at the time of the procedures were 12.9 ± 5.4 years old for BAT, and 17.4 ± 1.9 years old for PLT. Mean operative time was 173 ± 37 minutes in the BAT group, and 145 ± 39 minutes in the PLT group (P = 0.19). Patients received epidural analgesia in all cases; this was for a mean time of 3.8 ± 1.3 days in the BAT group, and 3.21 ± 4 days in the PLT group (P = 0.36). Chest tubes were removed after 3.6 ± 1.3 days in the BAT group, and 3 ± 1.2 days in the PLT group (P = 0.69). Total hospital stay was 7.7 ± 6.6 days in the BAT group, and 7 ± 1.2 days in the PLT group (P = 0.72).
  
  
  CONCLUSIONS
  In our experience, BAT seems suitable and shows outcomes similar to those of PLT for sarcoma metastasis resection. The BAT procedure allows the manual exploration of both lungs during a single surgical intervention, and so reduces the delay of further therapies.
authors: Olivier
authors: O
authors: Abbo
authors: Ramona
authors: R
authors: Guatta
authors: Kalitha
authors: K
authors: Pinnagoda
authors: Service de Chirurgie Pédiatrique, CHUV, 1011 Lausanne, Switzerland. jean-marc.joseph@chuv.ch.
authors: Jean-Marc
authors: JM
authors: Joseph
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis*; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D056346:Sternotomy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*