Surgeons at Cedars-Sinai used minimally invasive robotic technology to diagnose and remove an uncommon airway tumor in a young patient.
RT’s Three Key Takeaways:
- Rare Pediatric Diagnosis: Bronchopulmonary mucoepidermoid carcinoma is an exceptionally uncommon lung cancer in children, occurring in fewer than 0.2 cases per million pediatric tumors.
- Minimally Invasive Intervention: Surgeons utilized robotic bronchoscopy for airway biopsy and robot-assisted thoracic surgery to resect the tumor and the lower left lobe, avoiding open-chest surgery.
- Cross-Specialty Collaboration: Applying adult thoracic surgical robotic expertise within a pediatric healthcare environment allowed the patient to be discharged two days after surgery and remain cancer-free two years later.
Surgeons at Cedars-Sinai successfully used minimally invasive robotic surgery to remove an ultra-rare pediatric lung tumor in a 12-year-old patient, according to the organization.
The patient, Angela Beltran, initially developed a persistent cough and respiratory distress before a computed tomography (CT) scan revealed a lesion on her left lung, prompting referral to Cedars-Sinai Guerin Children’s in Los Angeles.
“I examined her scans and noticed the tumor was arising out of one of the branches of the windpipe called a bronchus. It looked like bronchopulmonary mucoepidermoid carcinoma,” said Leo Mascarenhas, MD, director of pediatric hematology and oncology at Cedars-Sinai Guerin Children’s. “It’s really seen in adults. But I’ve taken care of a few cases over the years, and it can occur in children even though it’s very, very rare.”
Bronchopulmonary mucoepidermoid carcinoma originates in the mucus-producing glands of the airways and accounts for fewer than 0.2 cases per million pediatric tumors.
Robotic Bronchoscopy and Surgical Resection
To confirm the diagnosis without opening the chest cavity, Andrew Brownlee, MD, an adult thoracic surgeon at Cedars-Sinai, collaborated with Eugene Kim, MD, surgeon-in-chief at Guerin Children’s, to perform a robotic bronchoscopy. The minimally invasive technology enabled the team to evaluate nearby lymph nodes and biopsy the 3-centimeter mass through the airway.
Although traditional open-chest surgery carries risks of protracted recovery times, prolonged hospital stays, and potential chest wall deformities as young patients grow, the surgical team determined that Beltran met the weight threshold required for robot-assisted thoracic surgery.
“One of the unique things that we can offer here at Cedars-Sinai is that this is a children’s hospital within an adult medical center,” said Dr Brownlee. “We perform robotic thoracic surgery in adults multiple times per week. That experience allows us to bring this highly specialized expertise to a child when appropriate.”
Clinical Outcome and Long-Term Recovery
Surgeons removed the 3-centimeter tumor along with the lower left lobe of the patient’s lung within a week of her diagnosis. The patient was discharged from the hospital two days after the procedure and has remained cancer-free two years later, undergoing surveillance evaluations every six months.
The clinical team credited the successful management of the rare oncology case to integrated coordination across medical divisions.
“We’ve been building a collaboration among pediatric surgery, oncology, and thoracic surgery for many years now,” said Dr Kim. “The goal has always been to bring together the best aspects of each division to offer something truly unique to our patients. Much of that expertise involves minimally invasive techniques that may not be readily available at dedicated children’s hospitals.”
