Minimally invasive surgery in children with cancer

Abstract

Background. The safety and efficacy of minimally invasive oncologic procedures in children have not been well defined and only limited anecdotal experience has been published. Methods. A retrospective review of all patients undergoing either a laparoscopic or thoracoscopic procedure at Childrens Cancer Group institutions between December 1, 1991, and October 1, 1993, was performed. Results. Eighty‐five children underwent 88 minimally invasive surgical procedures as part of the evaluation or treatment for cancer at 15 participating centers. In 25 patients, laparoscopy was performed and 60 patients underwent 63 thoracoscopic operations. Tissue biopsies were taken in 67 cases and diagnostic material was obtained in 99% of the biopsies. Seven complications occurred, all within the thoracoscopic group. These included conversion of six operations to an open procedure. One patient developed atelectasis postoperatively. Conclusions. In pediatric patients with suspected cancer, laparoscopy was highly accurate with minimal morbidity; thoracoscopy was nearly as efficient with slightly higher morbidity. Both modalities are useful for assessment of resectability, for staging purposes, and for evaluation of recurrent or metastatic disease.

CO2 pneumoperitoneum increases systemic but not local tumor spread after intraperitoneal murine neuroblastoma spillage in mice

“…This suggests that laparoscopy could promote systemic dissemination of intraperitoneally spilled tumor cells when no chemotherapy is applied. It remains to be determined whether this is due to local immune suppression or direct modulation of tumor cell behavior.Keywords Endoscopy Á CO 2 pneumoperitoneum Á Tumor spillage Á Local metastasis Á Systemic metastasis Á Neuroblastoma Laparoscopic surgery is increasingly accepted in pediatric malignancies [12,38]. Today, almost all solid pediatric tumors have been reported to undergo minimally invasive biopsy and, to a lesser extent, minimally invasive resection [12,16,31,38].…”

“…Today, almost all solid pediatric tumors have been reported to undergo minimally invasive biopsy and, to a lesser extent, minimally invasive resection [12,16,31,38]. However, the impact of CO 2 used for pneumoperitoneum on the behavior and potential progression of malignant tumors is controversial [3].…”

Applications of videolaparoscopic surgery in children

“…As principais aplicações nas quais a laparoscopia é considerada verdadeiro avanço terapêutico por nós e outros cirurgiões são a DRGE com ou sem hérnia hiatal 8,9 , a criptorquia alta 10,11 , o abdome agudo com dúvida diagnós-tica, sobretudo em meninas adolescentes 1,12,13 , o trauma abdominal fechado ou aberto (faca ou arma de fogo) 14 , a obstrução por bridas 15,16 , o megacólon congênito (dispensando a colostomia) 6,17 , as doenças do ovário 18,19 , a colecistectomia 20 , a esplenectomia 6,21 , o diagnóstico por bióp-sias 1,6,22 , o estadiamento de doença de Hodgkin ou outros tumores 23,24 , as hérnias diafragmáticas, o volvo gástrico 25 , os cistos ou divertículos, a investigação de icterícia e hérnia inguinal contralateral 1,26,27 . Além das indicações cirúrgi-cas citadas na Tabela 1, há muitas outras já publicadas que ainda não utilizamos.…”

“…Consideramos que, em crianças magras e sem evidência de plastrão, a operação convencional com pequena incisão ainda é mais vantajosa. Na cirurgia oncológica pediátrica, a introdução da videolaparoscopia para a realização de procedimentos, como biópsias e estadiamentos, com mínima invasão e rápida recuperação pós-operatória, tem permitido o início precoce de quimioterapia para os diversos tumores, com menor risco de deiscências de parede e infecção 22,23 . Em operações em cavidade aberta, normalmente se recomenda iniciar a quimioterapia ou radioterapia após a cicatrização da laparotomia (8 a 10 dias), mesmo assim com alto risco de deiscência, infecção e hérnias incisionais.…”

Thoracoscopic surgery in the management of pediatric malignancies: a multicentric survey of the Italian Society of Videosurgery in Infancy

“…About 30% to 40% of pediatric oncologic patients have pulmonary metastases, with only the lungs affected [9,13]. For selected patients, exeresis of the pulmonary nodules can mean total remission.…”