In a landmark surgery, doctors at Narayana Health SRCC Children's Hospital, Mumbai, successfully treated a rare and complex mediastinal mass extending into the abdomen in a 7-year-old girl using advanced thoracoscopic, that is, minimally invasive techniques that ensured faster recovery and minimal scarring.
The child had initially developed a lower respiratory tract infection three months ago, following which radiological investigations revealed the presence of a tumour. An ultrasound-guided biopsy confirmed the diagnosis, and given the mass's precarious location, the surgical team opted for thoracoscopic excision instead of conventional open surgery.
The tumour was positioned posterolaterally along the D10–L1 vertebrae, lying partly above and below the diaphragm. Its close proximity to critical structures—including the aorta and the thoracic duct—made it especially challenging, even for open surgery.
Despite these risks, the surgical team was able to completely excise the tumour along with its capsule, all while safeguarding vital thoracic and abdominal structures and avoiding potentially life-threatening complications.
Thanks to the minimally invasive approach, the girl's recovery was rapid. She was able to begin oral intake on the first postoperative day, walk by the second day, and was discharged on the third.
"Thoracoabdominal tumours in children require extreme precision and care," said Dr. Rasik Shah, senior consultant, paediatric surgery, who led the surgery. "In this case, the tumour's location near the aorta, thoracic duct, and diaphragm, with part of it extending into the abdomen, made it particularly challenging. Thoracoscopic surgery allowed meticulous removal without damage while ensuring less pain, faster recovery, and a cosmetically better scar compared to open surgery."
Echoing this, Dr. Zubin Pereira, Facility Director at Narayana Health SRCC Children's Hospital, said: "This case showcases our hospital's virtuosity in performing such complex surgeries. Our focus is always on combining safety, precision, and compassion to give children the best possible outcomes."
In the Paediatric Haematology Oncology journal, authors from Sri Ramachandra Institute of Higher Education and Research, Radiodiagnosis, Chennai, India, write about the case of a 3-year-old with multifocal thoracoabdominal neuroblastoma. The 3-year-old girl presented with abdominal distension that her mother had noticed for 2 weeks. The child had no dysmorphic features; her abdominal examination revealed an ill-defined mass of 10 × 10 cm occupying the left half of the abdomen. "Surgical challenges in thoracoabdominal tumours are unique, and expertise is needed. Pediatric oncologists should be aware of this entity, and this is why it is very important to screen family members and carry out genetic testing in such cases," the paper reads.
In another paper published in Acta Medica, titled 'Thoracoabdominal Approach for Giant Tumour Resection in Children,' authors from Hacettepe University in Ankara, Turkey say that 'the thoracoabdominal incision for difficult upper abdominal tumour is tolerated well by the patients. The enhanced exposure facilitates resection and improves local control.'
The authors further noted that "traditional incisions often fall short in providing the access required for complete removal of large tumours. The thoracoabdominal incision offers superior exposure of vascular structures and facilitates excision of massive upper abdominal and lower thoracic tumours."
This retrospective study reviewed the outcomes of 11 children operated on between 2015 and 2020 at one institution for neuroblastoma, adrenocortical carcinoma, and Wilms tumour using this approach. The median age at surgery was 58 months. Postoperative recovery was smooth across all cases, with morphine-based pain control required only for the initial two days, no pulmonary complications reported, and discharge achieved within a median of five days. At a median follow-up of 12 months, outcomes were favourable, noted the study.