Journal of pediatric surgery · 2026
Trap-door approach for complex pediatric thoracic inlet tumors with vascular encasement: Safety and resection outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Deng Xiaobin, Li Changchun, Wu Chun, Wang Shan
Аннотация
BACKGROUND/PURPOSE: Minimally invasive techniques are increasingly used for pediatric thoracic disease; however, tumors at the cervicothoracic junction (CTJ) remain technically demanding when they involve major vessels and densely packed neural structures. We assessed the perioperative safety and oncologic adequacy of the Trap-door cervicothoracic thoracotomy for these complex lesions and sought to clarify its role in the contemporary era.
METHODS: We retrospectively reviewed 25 consecutive children (median age, 5.1 years; range, 1.3-14.5) who underwent CTJ or upper mediastinal tumor resection using the Trap-door approach at a single high-volume center from December 2021 to June 2025. Demographics, imaging features (including image-defined risk factors), operative metrics, extent of resection, and perioperative complications were collected and summarized.
RESULTS: Neuroblastoma was the most frequent diagnosis (n = 15, 60%). Preoperative imaging showed major vascular encasement in 60% of patients. Gross total resection (GTR) was achieved in 24 patients (96%). Median operative time was 234 min (range, 54-456), and median estimated blood loss was 50 mL (range, 5-600). No perioperative deaths occurred. Postoperative morbidity was mainly pulmonary (52%), followed by Horner syndrome (28%) and transient recurrent laryngeal nerve dysfunction (8%).
CONCLUSIONS: The Trap-door approach offers broad and controllable exposure for complex CTJ tumors, enabling high rates of complete macroscopic resection with acceptable morbidity. As minimally invasive options expand, this open incision remains important for bulky tumors with vascular encasement, where secure vascular control and oncologic clearance outweigh cosmetic considerations.
LEVEL OF EVIDENCE: Level IV (retrospective case series).
METHODS: We retrospectively reviewed 25 consecutive children (median age, 5.1 years; range, 1.3-14.5) who underwent CTJ or upper mediastinal tumor resection using the Trap-door approach at a single high-volume center from December 2021 to June 2025. Demographics, imaging features (including image-defined risk factors), operative metrics, extent of resection, and perioperative complications were collected and summarized.
RESULTS: Neuroblastoma was the most frequent diagnosis (n = 15, 60%). Preoperative imaging showed major vascular encasement in 60% of patients. Gross total resection (GTR) was achieved in 24 patients (96%). Median operative time was 234 min (range, 54-456), and median estimated blood loss was 50 mL (range, 5-600). No perioperative deaths occurred. Postoperative morbidity was mainly pulmonary (52%), followed by Horner syndrome (28%) and transient recurrent laryngeal nerve dysfunction (8%).
CONCLUSIONS: The Trap-door approach offers broad and controllable exposure for complex CTJ tumors, enabling high rates of complete macroscopic resection with acceptable morbidity. As minimally invasive options expand, this open incision remains important for bulky tumors with vascular encasement, where secure vascular control and oncologic clearance outweigh cosmetic considerations.
LEVEL OF EVIDENCE: Level IV (retrospective case series).