How Robotic Surgery Helped Tackle a Rare Pediatric Lung Tumor

When 12-year-old Angela Beltran developed a persistent cough that left her struggling to breathe, her mother knew something was seriously wrong.

"The last cough she had scared me. She woke up and she couldn't breathe," said Anita Sanchez, Angela's mother.

Sanchez rushed Angela to a physician in her hometown of Sinaloa, Mexico. After initial scans were inconclusive, she brought Angela to Los Angeles for further testing. When a CT scan revealed a small white patch on her left lung, Angela was referred to Leo Mascarenhas, MD, director of Pediatric Hematology and Oncology at Cedars-Sinai Guerin Children's.

When Mascarenhas took a close look at Angela's scans, he suspected it to be an exceptionally rare lung tumor.

"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," he said. "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 is an ultra-rare form of lung cancer that arises in the mucus-producing glands of the airways and is typically seen in adults. In children, it is exceedingly rare, accounting for fewer than 0.2 cases per million pediatric tumors.

The next day, Andrew Brownlee, MD, an adult thoracic surgeon who primarily cares for adults at the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai, collaborated with Eugene Kim, MD, surgeon-in-chief at Guerin Children's, to perform a robotic bronchoscopy.

This minimally invasive technology allows physicians to biopsy tumors and examine nearby lymph nodes through the airway without opening the chest.

The biopsy confirmed Mascarenhas' suspicions. Angela had a 3-centimeter tumor lodged by the branch of the windpipe in her left lung. Fortunately, the cancer hadn't spread elsewhere in the body. Surgery was the only option to remove the tumor.

"As a mother, I think I could feel something was wrong, but I never imagined it would be this bad," Sanchez said. "But Dr. Brownlee was confident he could take out the tumor, so I was grateful she was in good hands."

Traditional open-chest surgery can mean a longer recovery, time away from school and potential chest wall deformities as children grow. Brownlee instead suggested a minimally invasive robot-assisted surgery. Angela was just above the weight threshold needed for the procedure.

"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," Brownlee said. "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."

The surgery was successful. Within a week after receiving the devastating diagnosis, Angela had the tumor removed along with the lower left lobe of her lung. Just two days later, she was discharged from the hospital.

Two years later, Angela, now 14, remains cancer-free. She returns to Los Angeles every six months for follow-up visits with Mascarenhas. Back home in Sinaloa, she's busy being a teenager, spending time with her siblings and navigating high school.

"When I was first told I had lung cancer, I felt nervous and scared. But since everything is fine now, I feel much better. I feel like everything is still going to be OK," Angela said.

Mascarenhas credits Angela's outcome to the multidisciplinary team he was able to quickly assemble to care for her-an approach Kim says sets Guerin Children's apart.

"We've been building a collaboration among pediatric surgery, oncology and thoracic surgery for many years now," Kim said. "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."

Sanchez is grateful she brought her daughter to Los Angeles for care.

"I think that she couldn't have had this type of care anywhere else," Sanchez said. "We had the best doctors and nurses. They're the people who saved my daughter's life. And I'm always going to be thankful for that."

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