Clamshell thoracotomy for pediatric tumor resection: A case series

Large masses in the pleural cavity or mediastinum in pediatric patients may present an operative challenge, not only in terms of obtaining adequate space in the small chest for safe dissection, but in attaining adequate chest closure. Three adolescent males presented with large masses in the mediastinum or thoracic cavity. Their presenting signs were primarily chronic cough and chest pain. Patient 1 was a 13-year-old male with a history of spina bifida and a 12 × 10 × 9 cm malignant germ cell tumor in the mediastinum/right chest. Patient 2 was an 18-year-old male with a 24 × 15 × 11 cm right thoracic synovial sarcoma in the posterior mediastinum/right hemithorax. Patient 3 was a 14-year-old male with a 19 × 14 × 10 cm lymphovascular malformation in the posterior mediastinum/right hemithorax. In all three patients, after the resection of the tumor via a clamshell throacotomy, sternal plating was employed for sternal wound closure. Post operative complications included a superficial surgical site infection and a chyle leak, but no wound dehiscence or breakdown. The bilateral clamshell thoracotomy is a suitable approach for the resection of extensive mediastinal and thoracic masses in adolescents. The use of a sternal plate leads to adequate sternal healing.