Trap-Door Thoracotomy and Clamshell Thoracotomy as Surgical Approaches for Neuroblastoma and Other Thoracic Tumors in Children

Simple Summary Solid thoracic tumors in children are rare, with neuroblastoma being the most commonly diagnosed tumor entity. A safe and complete tumor resection is often not possible with a unilateral cervical approach, sternotomy, thoracotomy, or bilateral thoracotomy (single or staged) in certain localizations of the thorax, such as the cervicothoracic junction, the posterior mediastinum, or bilateral dorsal thoracic tumors. In adults, trap-door thoracotomy has been established and evaluated as a safe surgical approach for tumors of the cervicothoracic junction and clamshell thoracotomy as a safe surgical approach for posterior mediastinal or bilateral dorsal thoracic tumors. The aim of this study was to evaluate the surgical and oncologic implications of trap-door thoracotomy and clamshell thoracotomy in children with solid tumors in these specific localizations. These findings may have a positive impact on the quality of care and patient safety for children with solid thoracic tumors.Abstract Solid tumors of the cervicothoracic junction, the posterior mediastinum, or bilateral dorsal thoracic tumors represent a challenge in pediatric surgical oncology. The aim of this study was to evaluate trap-door thoracotomy and clamshell thoracotomy as surgical approaches. A single-center retrospective study of children with solid tumors in these specific localizations was performed. From 2015 to 2023, 26 children (17 girls; 9 boys) were treated at a median age of 54 months (range 8-229). Tumor resection was performed for neuroblastoma (n = 11); metastatic disease (n = 7); malignant rhabdoid tumor (n = 4); Ewing sarcoma (n = 1); inflammatory myofibroblastic tumor (n = 1); rhabdomyosarcoma (n = 1); and neurofibroma (n = 1). The surgical goal of macroscopic complete excision was achieved in all of the 14 children who underwent trap-door thoracotomy and in 11 of the 12 children who underwent clamshell thoracotomy. There were no major complications. At a median follow-up of 8 months (range 0-60), the disease was under local control or in complete remission in 66.7% of the children. In conclusion, surgical resection of solid tumors of the cervicothoracic junction in children can be performed safely and successfully with trap-door thoracotomy and with clamshell thoracotomy for posterior mediastinal or bilateral dorsal thoracic tumors.