Perioperative Management of Children, Adolescents and Young Adults Undergoing Surgical Treatment for Oncologic Thoracic Disease: Retrospective Single-Center Analysis.
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BACKGROUND: No guidelines drive the perioperative management of children, adolescents, and young adults (CAYA) undergoing oncologic thoracic surgery. We analyzed our institutional procedures and perioperative results aiming to help develop standardized guidelines. PROCEDURE: Records of CAYA patients operated on for a thoracic tumor (October 2021 to February 2025) were retrospectively analyzed. Standardized perioperative management included minimally invasive technique when feasible, early discharge to the ward, avoidance of sedation (drainage removal), systematic physiotherapy, early mobilization, and resumption of oral intake. Outcomes refer to the total number of surgeries. RESULTS: Forty-seven CAYA (median age 15, interquartile range [IQR]: 12-18) underwent 54 operations removing localized tumor in 20 (37%), metastases in 33 (61.1%), and one (1.9%) local recurrence. In 36 cases (66.7%), surgery followed chemotherapy after 29.5 days (median; IQR: 22-47.3); in seven (13%), it was performed on a previously irradiated site. Eighteen procedures (33.3%) required resection of more than one organ; 17 (31.5%) were minimally invasive. In 10 (18.5%) cases, the first postoperative night was spent in the intensive care unit. Oral intake was resumed within postoperative day (POD) 1 in 46 (85.2%). Despite physical limitations to ambulation in 12 (22.2%) cases, in 49 (90.7%) the patient was mobilized and in 38 (70.4%) walked within POD1. Continuous intravenous opioid infusion was necessary in 23 (42.6%) cases, and sedation for drainage removal in one. There were 19 complications (35.2%), 89.5% of which were Grade I-II. Patients were discharged on POD5 (median, IQR: 4-8). CONCLUSIONS: Standardized perioperative management in CAYA is possible and can lead to early mobilization and a low complication rate, despite complex complementary treatments (chemotherapy/radiotherapy) and limited access to intensive care resources.