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CT-guided methylene blue staining to facilitate thoracoscopic resection of intermediate-to-deep pulmonary metastases in pediatric patients

Year: 2026

Type: article

Abstract: PURPOSE: Thoracoscopic resection of pulmonary metastases offers a minimally-invasive approach but requires preoperative localization due to absent tactile feedback. CT-guided methylene blue staining (MBS) was implemented to facilitate resection of pulmonary metastases, including intermediate-to-deep lesions. METHODS: We retrospectively analyzed pediatric patients (0-18 years) undergoing resection of pulmonary metastases (2007-2024). Lesion depth was classified as superficial (≤ 10 mm), intermediate (11-20 mm), or deep (> 20 mm). Primary endpoint was completeness of resection; secondary endpoints included perioperative and oncological outcomes. Subgroup analysis included patients with ≤ 2 pulmonary metastases. RESULTS: Fifty-eight resections in 43 patients were included: 49 open, and 9 thoracoscopic following CT-guided MBS. Eleven lesions were stained prior to thoracoscopic resection: three superficial, seven intermediate, one deep lesion. All were resected with negative margins, without complications. Thoracoscopy following CT-guided MBS was associated with shorter operative times (65 vs. 157 min, p = 0.01), hospital stay (4.0 vs. 5.6 days, p = 0.01), and time-to-chemotherapy-resumption (2.25 vs. 18.6 days, p = 0.01). No differences were observed in pulmonary recurrence, disease-free interval, or six-month-survival. CONCLUSION: In pediatric patients with up to two pulmonary metastases, CT-guided methylene blue staining provided feasible preoperative localization, facilitating thoracoscopic wedge resection of superficial, intermediate and deep lesions without complications. Prospective multicenter studies should further evaluate efficacy and inclusion criteria.

Source: Pediatric Surgery International

DOI: 10.1007/s00383-026-06675-1