title: Pulmonary metastasectomy in pediatric patients.
abstract: BACKGROUND
  This study aims to evaluate the outcomes of pulmonary metastasectomy resections in pediatric patients.
  
  
  METHODS
  We retrospectively reviewed the medical records of 43 children who were operated on in the Pediatric Surgery Clinic between January 1988 and 2014. Forty-three children (26 boys; 17 girls; mean age 10±4.24 years, range 6 months-18 years) who underwent pulmonary metastasectomy resection were included in the study. The patients were evaluated based on age, gender, history of disease, surgical procedures, complications, duration of hospitalization, duration of chest tube placement, and procedure outcome.
  
  
  RESULTS
  Indications for pediatric resections were oncological. Metastasis was secondary to Wilms' tumor in 14 patients, osteosarcoma in 7 patients, Ewing's sarcoma in 5 patients, rhabdomyosarcoma in 5 patients, lymphoma in 3 patients, hepatoblastoma in 2 patients, and other tumors in 7 patients. A total of 59 thoracotomies were performed. Approaches utilized included unilateral posterolateral thoracotomy (n=33), bilateral posterolateral thoracotomy (n=8), and sternotomy (n=2). Wedge resection was the procedure of choice (n=44). In selected cases, 11 segmentectomies, 3 lobectomies, and 1 pneumonectomy were performed. There was no perioperative mortality. One patient suffered prolonged air leak and three patients from fever. All patients received chemotherapy. Radiotherapy was administered to 16 patients (37.2%). Of those 16 patients, 7 had Wilms' tumor, 6 had Ewing's sarcoma/PNET, and 3 were rhabdomyosarcoma patients. During a median follow-up of 3 years, the overall survival was 74.4%.
  
  
  CONCLUSIONS
  Multidisciplinary treatment involving pediatric oncologists, surgeons, and radiation oncologists is necessary to obtain positive results in children who have pulmonary metastases of oncological diseases. Wedge resection is a suitable option for children because less lung tissue is resected.
authors.affiliation: Istanbul Faculty of Medicine, Department of Pediatric Surgery, Istanbul University, Oguz Goker Caddesi, 5. Gazeteciler Sitesi, C-1 Blok No. 36, Akatlar Mahallesi, Besiktas, Istanbul, Turkey. basakerginel@hotmail.com.
authors.forename: Basak
authors.initials: B
authors.lastname: Erginel
authors.affiliation: Istanbul Faculty of Medicine, Department of Pediatric Surgery, Istanbul University, Oguz Goker Caddesi, 5. Gazeteciler Sitesi, C-1 Blok No. 36, Akatlar Mahallesi, Besiktas, Istanbul, Turkey.|Department of Pediatric Hematology and Oncology, Istanbul University, Institute of Oncology, Istanbul, Turkey.
authors.forename: Feryal
authors.initials: F
authors.lastname: Gun Soysal
authors.affiliation: Istanbul Faculty of Medicine, Department of Pediatric Surgery, Istanbul University, Oguz Goker Caddesi, 5. Gazeteciler Sitesi, C-1 Blok No. 36, Akatlar Mahallesi, Besiktas, Istanbul, Turkey.
authors.forename: Erbug
authors.initials: E
authors.lastname: Keskin
authors.affiliation: Department of Pediatric Hematology and Oncology, Istanbul University, Institute of Oncology, Istanbul, Turkey.
authors.forename: Rejin
authors.initials: R
authors.lastname: Kebudi
authors.affiliation: Istanbul Faculty of Medicine, Department of Pediatric Surgery, Istanbul University, Oguz Goker Caddesi, 5. Gazeteciler Sitesi, C-1 Blok No. 36, Akatlar Mahallesi, Besiktas, Istanbul, Turkey.
authors.forename: Alaaddin
authors.initials: A
authors.lastname: Celik
authors.affiliation: Istanbul Faculty of Medicine, Department of Pediatric Surgery, Istanbul University, Oguz Goker Caddesi, 5. Gazeteciler Sitesi, C-1 Blok No. 36, Akatlar Mahallesi, Besiktas, Istanbul, Turkey.
authors.forename: Tansu
authors.initials: T
authors.lastname: Salman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008175:Lung Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies
references.citation: Gen Thorac Cardiovasc Surg. 2013 Oct;61(10):565-70
references.pmid: 23832549
references.citation: J Pediatr Surg. 2013 Apr;48(4):750-6
references.pmid: 23583129
references.citation: Bol Asoc Med P R. 2012 Jul-Sep;104(3):35-40
references.pmid: 23156890
references.citation: J Pediatr Surg. 2011 Jul;46(7):1333-7
references.pmid: 21763830
references.citation: Eur J Cardiothorac Surg. 2008 Dec;34(6):1240-6
references.pmid: 18835785
references.citation: Eur J Cardiothorac Surg. 2008 Jun;33(6):1135-8
references.pmid: 18396056
references.citation: Eur J Pediatr Surg. 2007 Apr;17(2):84-9
references.pmid: 17503299
references.citation: Thorac Surg Clin. 2006 May;16(2):167-83, vi
references.pmid: 16805206
references.citation: Semin Pediatr Surg. 2006 Feb;15(1):25-9
references.pmid: 16458843
references.citation: J Pediatr Surg. 2006 Jan;41(1):200-6; discussion 200-6
references.pmid: 16410133
references.citation: J Pediatr Surg. 2006 Jan;41(1):194-9
references.pmid: 16410132
references.citation: Surgery. 1994 Jun;115(6):687-93
references.pmid: 8197559
references.citation: Pediatr Surg Int. 2004 Aug;20(8):630-2
references.pmid: 15258816
references.citation: Thorac Cardiovasc Surg. 2004 Apr;52(2):90-5
references.pmid: 15103581