WOFAPS 2025 8th World Congress of Pediatric Surgery

Marzena Kozakiewicz ¹, Anna Tomkowiak ², Girish Sharma ², Paulina Maksymowicz ¹, Anna Wojtylko ¹, Malgorzata Rapala ¹, Jan Godzinski ¹

¹ Department of Pediatric Surgery, Marciniak Specialist Hospital, Wroclaw, Poland
² Lower Silesian Heart Disease Center named after Prof. Zbigniew Religa, MEDINET, Wroclaw, Poland

Background and Aim: Advanced solid tumors in children may infiltrate critical thoracic or cardiac structures, making surgical treatment particularly complex and high-risk. These challenging cases often require cooperation between pediatric oncological surgeons and pediatric cardiac surgeons.

Materials and Methods: We retrospectively reviewed 14 cases of pediatric patients aged 7 months to 13 years. Six of them presented with thoracic tumors (1 thymoma, 2 teratomas, 1 embryonal carcinoma, 1 pulmonary blastoma and 1 Ewing's sarcoma with lung metastases). Five children presented with abdominal tumors (4 nephroblastoma and 1 neuroblastoma) all with thrombus reaching the right antrium (3) and ventricle (1). In 3 heart tumors: 2 affecting the right atrium, 1 affecting the left ventricle. Surgical planning was coordinated in a multidisciplinary setting involving pediatric surgery and cardiac surgery.

Results: Each surgery due to high risk was secured by extracorporeal circulation (ECC) ready. Finally 7 patients required ECC-assisted resection, 7 were operated without ECC. Procedures wit ECC use requied sternotomy and laparotomy, except for cardiac tumors, which requied sternotomy only. There were no major complications. 2 children with removed teratoma and chidren with heart tumors did not require further treatment. The remaining children required chemotherapy and radioterapy.

Conclusions: A multidisciplinary surgical approach enables safe and effective management of advanced pediatric tumors involving the mediastinum and heart. The use of ECC increases the safety of complex resections in selected cases. Early involvement of a collaborative surgical team is essential to optimize outcomes and reduce treatment-related morbidity.