Role of diagnostic and ablative minimally invasive surgery for pediatric malignancies

Abstract

BACKGROUNDThe use of minimally invasive surgery (MIS) in pediatric cancer is a matter of debate. The diagnostic and ablative roles of MIS were evaluated in a consecutive series of children with malignancies.METHODSA prospective study, including all patients, who underwent abdominal and thoracic surgery for confirmed or highly suspected pediatric cancer was performed from September, 2000, to December, 2005. An interdisciplinary panel approved the indication for minimally invasive or conventional surgery.RESULTSAt a single institution, 301 operations were performed on 276 children with cancer. A minimally invasive approach was attempted in 90 of these patients (30%) and successfully employed in 69 (77%) of the operations. However, 21 operations (23%) were converted to an open approach. Regarding the abdominal operations attempted laparoscopically, 41 abdominal operations for biopsy or staging purposes were attempted laparoscopically (53%), but 6 were converted. In all, 139 abdominal resections were performed and 24 were attempted laparoscopically. Ten of these (42%) were converted. In 34 thoracic operations requiring biopsy, thoracoscopy was attempted in 14 (41%) and was successful in all but 1 (93%). Fifty‐one thoracic tumors were resected and the thoracoscopic approach was attempted in 11 (22%) and successful in 7 (14%). Conversions from a minimally invasive operation to an open procedure occurred mainly due to limited visibility. Three bleeding complications occurred with 1 patient requiring a blood transfusion. In addition, 1 small bowel injury occurred with immediate laparoscopic closure. There were no port site recurrences after a median of 39 months.CONCLUSIONSMIS is a reliable diagnostic tool for pediatric abdominal and thoracic malignancy. The role of ablative MIS in pediatric cancer remains limited. Cancer 2007. © 2007 American Cancer Society.

Laparoscopic and Computer-Assisted Surgery in Children

“…a recent series from our institution emphasized the important role of laparoscopy and thoracoscopy in pediatric tumors, mainly as a diagnostic tool. However, more than 20% (14 of 65 pediatric patients) with abdominal malignancies underwent successful minimally invasive tumor resection in our series (52). Nonetheless, the general acceptance of minimally invasive techniques for ablative procedures remains limited to date.…”

Pancreatic Tumors

“…A defi nitive diagnosis is diffi cult to establish, especially concerning the heterogeneity of most pancreatic tumors in childhood. Biopsy by laparoscopy for diagnostic purposes is a wellaccepted strategy in pediatric surgery (Metzelder et al 2007 ) . However, the assessment of resectability of a pancreatic tumor by laparoscopy is by far more diffi cult than by the open approach.…”

“…In principle, a tumor biopsy would be advantageous before making a decision for therapy. This biopsy could be done by fi ne-needle aspiration (Nadler et al 2002 ) , by laparoscopy (Metzelder et al 2007 ) , or by open incision. In fi neneedle aspiration, however, the amount of tissue obtained is often very small.…”

Endosurgery in Diagnosis of Tumor Diseases in Children

“…Так, в 2007 г. опубликованы данные о проведении 301 операции у 276 детей с онкопатологией [15]. У 90 пациентов были выпол-нены операции лапароскопическим способом, из них у 41 -лапароскопическая биопсия опухоли.…”

“…Авторы пришли к выводу, что лапароскопическая биопсия является надеж-ным диагностическим инструментом при опухоле-вом поражении брюшной полости у детей [16]. А на основании оценки пятилетнего опыта применения эндохирургии у детей со злокачественными ново-образованиями установлено, что этот метод должен быть включен в комплекс диагностических методов обследования при опухолевом процессе, так как позволяет не только визуализировать опухоль, но и выполнить биопсию, оценить распространенность процесса [15]. При этом в сравнении с диагности-ческой лапаротомией новый метод снижает риск послеоперационных осложнений, уменьшает выра-женность болевого синдрома и ускоряет период восстановления [17].…”