Minimally Invasive Surgery in Childhood Cancer: A Challenging Future

Peycelon, Matthieu; Audry, G.; Irtan, Sabine

doi:10.1055/s-0034-1396419

Cited by 13 publications

(6 citation statements)

References 74 publications

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“…The different localizations of PGL require a multidisciplinary discussion 12,29 among different specialists who should always be involved on the basis of the tumor site and invasiveness (ear, nose, and throat surgeons; vascular surgeons; and interventional radiologists), with the aim to perform a complete resection, avoiding severe surgical sequelae. In two patients in our series, angiographic embolization was used to reduce the mass before the surgery in one case and in association with systemic therapy to treat an unresectable mass in another case.…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytomas and paragangliomas in children: Data from the Italian Cooperative Study (TREP)

Virgone

Andreetta

Avanzini

et al. 2020

Pediatric Blood & Cancer

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Background: Pheochromocytomas (PCs) are neuroendocrine tumors arising from the chromaffin cells of the adrenal gland, and paragangliomas (PGLs) are their extra-adrenal counterparts arising from ganglia along the sympathetic/parasympathetic chain. Surgery is the cornerstone of treatment. A sporatic or inherited germline mutation is commonly associated. Materials and methods: Among over 1000 patients registered into the Tumori Rari in EtàPediatrica-rare tumors in pediatric age project-from 2000 to 2019, 50 were affected by PC/PGL. All clinical and therapeutic data were evaluated.Results: Twenty-eight patients had PC and 22 had PGL. Age at diagnosis ranged between 5 and 17 years. Thirty-five patients had symptoms related to catecholamine hypersecretion; in 7 of 50 patients, diagnosis was incidental or done during assessment of a familial syndrome. In all cases, conventional imaging was effective to assess the presence of a tumor. In addition, 18 of 38 functional imaging studies were positive (61%). Forty-eight patients were eligible for surgery: a complete resection was more frequently achieved in PC than in PGL (26/28 vs 11/22). All relapses were treated with surgery alone, surgery plus medical treatment, or chemotherapy alone; one PC with metastasis at diagnosis received radiotherapy only. Forty-four patients were in the first, second, or third complete remission (10/50 recurred; 8/10 carried a germline mutation). Five of 50 patients were alive with disease. One patient died of disease.Abbreviations: 18 F-DOPA, fluorine-18-L-dihydroxyphenylalanine; 18 F-FDG, fluorine-18-fluorodeoxyglucose; 123 I-MIBG, 123 iodium-metaiodobenzylguanidine; 177 Lu-DOTATATE, lutetium-177-DOTA 0 -Tyr 3 -octreotate; CT, computed tomography; EFS, event-free survival; Max, MYC-associated factor X; MRI, magnetic resonance imaging; NF1, neurofibromin 1; OS, overall survival; PC, pheochromocytoma; PET/CT, positron emission tomography/computed tomography; PGL, paraganglioma; Ret, rearranged during transfection; SDHA, succinate dehydrogenase complex flavoprotein subunit A; SDHAF2, succinate dehydrogenase complex assembly factor 2; SDHB, succinate dehydrogenase complex iron sulfur subunit B; SDHC, succinate dehydrogenase complex subunit C; SDHD, succinate dehydrogenase complex subunit D; TMEM127, transmembrane protein 127; TREP, Tumori Rari in Età Pediatrica-rare tumors in pediatric age; VHL, von Hippel-Lindau.

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Section: Discussionmentioning

confidence: 99%

Pheochromocytomas and paragangliomas in children: Data from the Italian Cooperative Study (TREP)

Virgone

Andreetta

Avanzini

et al. 2020

Pediatric Blood & Cancer

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“…For example, for pediatric thoracoscopic surgery, congenital diaphragmatic hernia (CDH) has been increasingly managed by thoracoscopic assisted repair than the traditional open repair due to its intra-op and postop benefits (13,14). The growing use of MIS in paediatric surgery has been extending across different subspecialties, from cardiac, urological, gastrointestinal surgeries to even thoracic and abdominal oncological surgeries in recent years (15). MIS is no doubt a promising surgical approach in pediatric surgery.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic removal of a displaced thoracoamniotic shunt in a newborn with antenatal pleural effusion—a case report

et al. 2020

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Thoracoamniotic shunt has been considered as a treatment for antenatal pleural effusion and complication is rare. In majority of cases, the shunt can be removed uneventfully. In this article, we reported a rare complication of shunt migration resulting in the need of thoracoscopic removal at newborn period.The patient born at 39+3 weeks of gestation suffered from antenatal chylothorax detected at 28 weeks and was managed by intrauterine thoracoamniotic shunt insertion. This was complicated by shunt displacement, which caused respiratory distress after birth requiring ventilatory support and progressive pleural effusion in this patient. To prevent further neonatal compromise, thoracoscopic removal of the retained shunt was done on day 7 of life followed by post-op chest drain insertion. Post-op condition was stable with resolution of respiratory distress, and the patient was discharge on post-op day 16. We would like to remind clinicians about this potential complication of thoracoamniotic shunt, which can pose a potential risk of severe neonatal compromise, and that it can be managed by minimal invasive surgery even in the newborn period.

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“…Surgery leading to ovarian transposition or ovarian cryopreservation are accomplished laparoscopically. This approach is of value in case of planned pelvic irradiation, since already radiation doses of 4-20 Gy may have contributed to loss of ovarian function, thus ovarian transpositions out of the pelvis into paracolic areas can be recommended (44).…”

Section: Ovarian Tumorsmentioning

confidence: 99%

Minimally Invasive Surgery in Pediatric Oncology: Proposal of Guidelines

et al. 2019

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Background/Aim: The objective of the study was to propose clinical guidelines for the use of minimally invasive surgery (MIS) in pediatric oncology. Patients and Methods: Two groups of experts, including pediatric surgeons and pediatric oncologists were created in order to establish strategies of diagnostic and therapeutic surgical management in pediatric oncology. Results: On the basis of the analysis of the existing literature, we elaborated guidelines that were graded according to the simple practical clinical system: yes/no. This project was dedicated to the following topics: adrenal tumors including neuroblastoma, renal tumors including Wilms tumor (nephroblastoma), ovarian tumors and pulmonary nodules and metastases (osteosarcoma). Conclusion: Although existing data do not allow the recommendation of the use of MIS for all indications, this technique should currently be regarded as a standard of care in several areas of pediatric oncology. Minimally invasive surgery (MIS), in contrast to open surgery, is a technique that limits the size of incisions that allow access to peritoneal or thoracic cavities, followed by the use of laparoscope or thoracoscope for visualization and precise dissection. The same target operation should be performed via an open technique or a minimally invasive approach (1-3). The concept of MIS in children with cancer was used for the first time by Holocomb et al. (4), who showed laparoscopy and thoracoscopy to be highly accurate with minimal morbidity for the patient. Both modalities were useful for biopsies, assessment of resectability, staging, evaluation of metastatic or recurrent disease, assessing the potential benefit of second-look procedures, and for diagnosis of infectious complications. The development of this technology has been possible with improved visualization of anatomical structures (5). Subsequent studies and analyses confirmed that MIS procedures in pediatric oncology are safe and effective, resulting in earlier administration of adjuvant therapy. MIS is a developing concept, however in contrast to many areas in adults (6-8), there are no clear guidelines or recommendations in pediatric oncology, mainly due to heterogeneity of clinical diagnoses and small numbers of patients included in the studies. Thus, the aim of this study was to propose clinical guidelines for the use of MIS in pediatric oncology. Guideline Development Overview Two initial groups of experts, including pediatric surgeons and pediatric oncologists were created in order to establish strategies of diagnostic and therapeutic surgical management in pediatric oncology. According to our own experience the relevant issues of MIS utilization in pediatric oncology were defined as follow: adrenal tumors including neuroblastoma (NBL), renal tumors including Wilms tumor (WT), ovarian tumors, pulmonary nodules and metastases. The main desired outcome was evidence of a reduction in open surgery, and secondary outcomes included efficacy and safety, expressed as rate of complications. We performed Pub Med sea...

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Minimally Invasive Surgery in Childhood Cancer: A Challenging Future

Abstract: MIS is a promising method for removal of thoracic and abdominal malignancies as long as oncological principles are strictly followed. Long-term follow-up is mandatory to further delineate objective indications.

Cited by 13 publications

References 74 publications

Pheochromocytomas and paragangliomas in children: Data from the Italian Cooperative Study (TREP)

Pheochromocytomas and paragangliomas in children: Data from the Italian Cooperative Study (TREP)

Thoracoscopic removal of a displaced thoracoamniotic shunt in a newborn with antenatal pleural effusion—a case report

Minimally Invasive Surgery in Pediatric Oncology: Proposal of Guidelines

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