Thoracoscopy for Pediatric Thoracic Neurogenic Tumors—A European Multi-Center Study

SIMPLE SUMMARY: Surgery remains the main treatment for thoracic neurogenic tumors. However, with the development of the minimally invasive approach, few studies so far have defined the indications for thoracoscopy in these tumors. We conducted a large retrospective multicenter study to define the role of thoracoscopy for neurogenic tumors. We identified 119 patients from 15 centers over 20 years. The median operative time was 2 h, and the length of stay was 4 days. The conversion rate was 11%, the long-term complication rate (Horner’s and back issues) was 11%, the residue rate was 11.8%, the relapse rate was 7.5%, and 4% of patients died of their disease. The risk for conversion was associated with the need for chemotherapy. Complications were related to the IDRFs, the residue rates associated with persisting bronchial or vascular IDRF, and size but not on multivariate analysis. Recurrences were associated with neuroblastoma histology and unfavorable tumor biology. ABSTRACT: Objectives: To assess the efficacy of thoracoscopy and the outcome for children with thoracic neurogenic tumors. Methods: We performed a retrospective review of 15 European centers between 2000 and 2020 with patients who underwent thoracoscopy for a neurogenic mediastinal tumor. We assessed preoperative data, complications, and outcomes. Results were expressed with the median and range values. Results: We identified 119 patients with a median age of 4 years old (3 months–17 years). The diameter was 5.7 cm (1.1–15). INRG stage was L1 n = 46, L2 n = 56, MS n = 5, M n = 12. Of 69 patients with image-defined risk factors (IDRF), 29 had only (T9–T12) locations. Twenty-three out of 34 patients with preoperative chemotherapy had an 18 mm (7–24) decrease in diameter. Seven out of 31 patients lost their IDRF after chemotherapy. Fourteen had a conversion to thoracotomy. The length of the hospital stay was 4 days (0–46). The main complications included chylothorax (n = 7) and pneumothorax (n = 5). Long-term complications included Horner’s syndrome (n = 5), back pain, and scoliosis (n = 5). Pathology was 53 neuroblastomas, 36 ganglioneuromas, and 30 ganglioneuroblastomas. Fourteen had a postoperative residue. With a median follow-up of 21 months (4–195), 9 patients had a recurrence, and 5 died of disease. Relapses were associated with tumor biology, histology, and the need for chemotherapy (p = 0.034, <0.001, and 0.015, respectively). Residues were associated with preoperative IDRF (excluding T9–T12 only) and the need for preoperative chemotherapy (p = 0.04 and 0.020). Conclusion: Our results show that thoracoscopy is safe, with good outcomes for thoracic neurogenic tumors in selected cases. Surgical outcomes are related to the IDRFs, whereas oncologic outcomes are related to tumor histology and biology.