MEDIAN STERNOTOMY FOR THE RESECTION OF BILATERAL PULMONARY METASTASESIN CHILDREN

Childhood cancer often results in pulmonary metastases, and proper ide ntification and prompt treatment of these lesions increases the surviv al of these patients. Between 21 May 1995 and 26 June 1996, nine child ren (five with osteosarcoma, two with Wilms' tumor, and one each with hepatoblastoma and an adrenocortical tumor) underwent median sternotom y at our institution for resection of bilateral pulmonary metastases. These five boys and four girls ranged in age from 2 to 16 years (media n, 11 years). Identification and resection of metastases in all lobes of the lungs was greatly facilitated by the median sternotomy approach because both thoracic cavities were fully accessible. In each of five patients, as many as 23 metastases were removed using wedge resection or a stapling device. Multiple biopsies only were obtained from the f our remaining patients, whose lesions were too numerous and diffuse fo r effective resection. All nine patients recovered uneventfully; the m edian hospitalization was 3 days (range, 2-5 days). We find that media n sternotomy is a safe, effective, and relatively simple procedure for resecting bilateral pulmonary metastases in children with cancer.