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Eur J Cardiothorac Surg 2007;31:725-730. doi:10.1016/j.ejcts.2007.01.026
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Surgical treatment of malignant mediastinal neurogenic tumors in children

^a Department of Thoracic and Cardiovascular Surgery, Cancer Research Institute, Seoul National University Hospital, Xenotransplantation Research Center, Clinical Research Institute, Seoul National University College of Medicine, Seoul, South Korea
^b Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Kyeonggi-do, South Korea

Received 2 September 2006; received in revised form 23 December 2006; accepted 15 January 2007.

^_* Corresponding author. Address: Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 28 Yongon-dong, Jongro-gu, Seoul 110-744, South Korea. Tel.: +82 2 2072 3010; fax: +82 2 762 3566. (Email: chkang{at}snu.ac.kr).

Introduction: The aim of this study was to identify the role of surgical resection in the treatment of malignant mediastinal neurogenic tumors in children. Materials and methods: Thirty-eight consecutive children, who underwent surgical resection of a malignant mediastinal neurogenic tumor between 1986 and 2004, were included in this study. The tumor cell types were neuroblastoma in 23 patients (60.5%), ganglioneuroblastoma in 14 (36.8%), and malignant neuroepithelioma in 1 (2.6%). Surgery was performed for curative resection in localized tumors and salvage resection of residual mediastinal masses after chemotherapy in stage IV tumors. Of the 16 patients (42.1%) who underwent salvage resection, 14 had neuroblastoma and 2 ganglioneuroblastoma. Results: Mean patient age was 3.4 ± 3.0 years (1 month–13 years) and 26 patients (68.4%) were symptomatic at presentation. Adjacent structure invasion was found in eight patients (21.1%), invasion of chest wall in four, heart and vena cava in two, lung in one, and chest wall and lung in one. Complete gross resection was possible in 30 patients (78.9%) and there was no surgical mortality. Surgical morbidity occurred in 10 patients (26.3%) and Horner's syndrome was the most frequent complication (n = 7). The 5-year survival was 95.2% for a localized tumor and 52.5% for a stage IV tumor (p = 0.004). The significant risk factors of long-term survival were adjacent structure invasion (p = 0.002) and a stage IV tumor (p = 0.002) by multivariate Cox regression analysis. Conclusions: Surgical resection of localized malignant mediastinal neurogenic tumor in children showed good long-term survival, and salvage operations after chemotherapy showed acceptable long-term survival.

Key Words: Neuroectodermal tumors • Surgery • Survival