Subxiphoid Thoracoscopic Resection of Anterior Mediastinal Tumors in Children: Preliminary Clinical Experience

Objective To investigate the feasibility and short-term clinical outcomes of subxiphoid thoracoscopic surgery for the treatment of anterior mediastinal tumors in children, and to summarize the preliminary surgical experience. Methods A retrospective observational study was conducted on 4 pediatric patients who underwent subxiphoid thoracoscopic resection of anterior mediastinal tumors at our center from January 2024 to December 2024. Clinical data including pathological types, surgical procedures, intraoperative parameters, postoperative complications and their management were collected and analyzed. The inclusion criteria were central or unilateral anterior mediastinal tumors with a diameter less than 1/3 of the thoracic cavity and clear boundaries with major mediastinal blood vessels on imaging. Patients with pectus excavatum, giant tumors, or tumor invasion of major blood vessels were excluded. Results All 4 patients were male, aged 9 to 12 years. The pathological diagnoses included thymoma, mature cystic teratoma, and residual mediastinal mass after chemotherapy for T-lymphoblastic lymphoma. All surgical procedures were successfully completed via subxiphoid thoracoscopy without conversion to open thoracotomy. The median intraoperative blood loss was less than 20 mL, and no allogeneic blood transfusion was required in any patient. The median postoperative hospital stay was 7 days (range, 6–8 days). Mild postoperative complications (Clavien-Dindo grade Ⅰ) occurred in 2 patients (50%), including atelectasis and pleural effusion, all of which were completely resolved by conservative treatment or thoracostomy tube drainage without adverse effects on short-term prognosis. All tumors were resected with R0 margins, and pathological examination confirmed no residual tumor cells at the surgical margins. Conclusion Subxiphoid thoracoscopic resection is a feasible and safe minimally invasive approach for selected pediatric patients with anterior mediastinal tumors, with the advantages of mild postoperative pain, no severe perioperative complications and satisfactory short-term outcomes. However, the narrow operative space caused by the small thoracic cavity in children increases the surgical difficulty of this technique. The development of pediatric-specific auxiliary surgical instruments and the accumulation of more clinical cases are required to verify its long-term safety and efficacy.