WOFAPS 2025 8th World Congress of Pediatric Surgery

sheetal uttaray, Sajid Qureshi, saif kaderi

TATA MEMORIAL HOSPITAL, MUMBAI, INDIA

Background:
Pediatric malignant mediastinal germ cell tumors (PMGCT) are rare and present significant surgical challenges due to their central thoracic location and propensity to involve critical mediastinal structures. This study evaluates the clinical outcomes and surgical difficulties encountered in managing PMGCTs at a tertiary cancer center in India, focusing on pericardial, vascular, and pulmonary involvement.

Methods:
A retrospective analysis was conducted on 29 children (≤16 years) with PMGCTs treated between 2010 and 2024. All cases were managed with a multidisciplinary approach, incorporating tumor marker assessment, imaging, risk stratification (MaGIC criteria), neoadjuvant chemotherapy, and surgical resection. Data on tumor biology, surgical approach, intraoperative findings, and postoperative outcomes were analyzed.

Results:
Median age at presentation was 12 years, with yolk sac tumors being the most common histology (72.4%). Surgical approaches included median sternotomy, clamshell thoracotomy, and combined incisions tailored to tumor extent. Major intraoperative challenges included dense pericardial adherence (requiring pericardiectomy in 3 cases), major vascular involvement including SVC thrombus and brachiocephalic vein encasement (requiring partial vein resection and repair in 4 patients), and extensive pulmonary infiltration necessitating lung wedge resections, lobectomies, and pneumonectomy. Two patients required cardiopulmonary bypass due to critical vascular or pericardial involvement. Postoperative complications included prolonged ventilation, hemorrhage, and one postoperative mortality due to hemorrhagic shock. Recurrence occurred in 24.1%, predominantly in mixed histologies. At a median follow-up of 13 months, 58.6% were alive and disease-free.

Conclusion:
PMGCTs pose significant surgical challenges due to frequent encasement or infiltration of the pericardium, great vessels, and lungs. Optimal outcomes require individualized surgical planning, a multidisciplinary approach, and readiness for complex thoracic procedures including vessel repair, pericardiectomy, and lung resections