1
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The Role of Biopsy in the Workup of Patients with Neuroblastoma: Comparison of the Incidence of Surgical Complications and the Diagnostic Reliability of Diverse Techniques. CHILDREN-BASEL 2021; 8:children8060500. [PMID: 34204830 PMCID: PMC8231485 DOI: 10.3390/children8060500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 12/18/2022]
Abstract
Neuroblastoma (NB) is the most common extracranial solid tumor in childhood, accounting for approximately 15% of all cancer-related deaths in the pediatric population. The overall survival of children with high-risk disease is around 40-50% despite the aggressive treatment protocols. In accordance with the most recent guidelines, a complete classification of the primary tumor, including its histopathological and molecular analysis, is necessary. In this regard, the biopsy of the primary tumor is an important diagnostic procedure adopted not only to confirm the diagnosis but also for staging and risk stratification of the disease. In this study, the authors describe their unicentric experience with four different approaches adopted for sampling NB tumors: (i) the open incisional biopsy; (ii) the minimally invasive thoracoscopic/laparoscopic incisional biopsy; (iii) the ultrasound-guided core needle biopsy; (iv) the laparoscopic-assisted core needle biopsy. The benefits of each technique are analyzed along with their contraindications.
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2
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Bien E, Roganovic J, Krawczyk MA, Godzinski J, Orbach D, Cecchetto G, Barthlen W, Defachelles AS, Ferrari A, Weldon CB, Brecht IB, Schneider DT, Bisogno G, Kolenova A, Ben-Ami T, Martinova K, Virgone C, Stachowicz-Stencel T, Kachanov D, Reguerre Y. Pancreatoblastoma in children: EXPeRT/PARTNER diagnostic and therapeutic recommendations. Pediatr Blood Cancer 2021; 68 Suppl 4:e29112. [PMID: 34174157 DOI: 10.1002/pbc.29112] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 12/17/2022]
Abstract
Pancreatoblastoma (PBL) is a rare malignant epithelial neoplasm that affects typically young children. Signs related to advanced upper-abdominal tumor accompanied by elevated serum α-fetoprotein levels in a young child suggest PBL, however histopathological confirmation is mandatory. The mainstay of the treatment is a complete surgical resection. Unresectable and/or metastatic PBL may become amenable to complete delayed surgery after neoadjuvant chemotherapy. This manuscript presents the international consensus recommendations for the diagnosis and treatment of children with PBL, established by the European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT) within the EU-funded PARTNER (Paediatric Rare Tumors Network - European Registry) project.
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Affiliation(s)
- Ewa Bien
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Jelena Roganovic
- Department of Pediatrics, Clinical Hospital Center Rijeka, University of Rijeka, Rijeka, Croatia
| | - Malgorzata A Krawczyk
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland.,Department of Pediatric Traumatology and Emergency Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Giovanni Cecchetto
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Winfred Barthlen
- Pediatric Surgery, Universitaetsmedizin Greifswald, Greifswald, Germany
| | | | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Christopher B Weldon
- Departments of Surgery, Oncology and Anesthesiology, Boston Children's Hospital, Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts, USA
| | - Ines B Brecht
- Pediatric Hematology and Oncology, Children's Hospital, Eberhard-Karls-Universitaet Tübingen, Tübingen, Germany
| | | | - Gianni Bisogno
- Hematology-Oncology Division, Department of Pediatrics, Padova University Hospital, Padua, Italy
| | | | - Tal Ben-Ami
- Pediatric Hematology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Kata Martinova
- Department of Hematology and Oncology, University Clinic for Children`s Diseases, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of North Macedonia
| | - Calogero Virgone
- Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Denis Kachanov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Yves Reguerre
- Department of Pediatric Hematology and Oncology, Félix Guyon University Hospital, St Denis, Réunion Island, France
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3
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Riccipetitoni G, Bertozzi M, Gazzaneo M, Raffaele A, Vatta F. The Role of Video-Assisted Thoracoscopic Surgery in Pediatric Oncology: Single-Center Experience and Review of the Literature. Front Pediatr 2021; 9:721914. [PMID: 34712630 PMCID: PMC8546295 DOI: 10.3389/fped.2021.721914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/06/2021] [Indexed: 01/25/2023] Open
Abstract
Aim: Video-assisted thoracoscopic surgery (VATS) has been widely used in the last decades. Nevertheless, the pros and cons of thoracoscopy vs. open surgery in pediatric oncology are still under debate. In literature, VATS has been applied for both diagnostic and ablative surgery to treat neurogenic tumors, thymic neoplasms, lung tumors and metastases, germ cell tumors, lymphoproliferative diseases, and other rare tumors. Recent reviews described excellent outcomes in pediatric oncology as well as in the treatment of adult lung cancer, with a significantly higher rate of mortality and complication in thoracotomy compared to VATS. We reviewed our experience on thoracoscopy in pediatric malignancy and compared it to the literature. Materials and Methods: This was a retrospective cohort-study of pediatric oncological patients who underwent VATS at our institution from 2007 to 2020, and a review of the recent literature on the topic. Results: A total of 43 procedures were performed on 38 oncological patients (18 males, 20 females). Median age was years 7.72 (0.35-18.6). Diagnosis: 10 neurogenic tumors, nine hematological diseases, five metastases, four lypoblastomas, three thymic pathologies, three germ cell tumors, two pleuropneumoblastomas, two myofibroblastic tumors, one myoepithelial carcinoma, one liposarcoma, and three suspected oncological mass. In three cases, a 3D model was elaborated to better plan the surgical approach. Diagnostic biopsies were 22 (51.1%), and ablative surgeries, 21 (48.9%). One neurogenic tumor was resected with the Da Vinci Robot. Median operative time was 120 min (30-420). A drain was left in place in 20 (46.5%) for a median of 4 days. Median length of hospitalization was 5 days (1-18). One case (2.3%) was converted (intraoperative bleeding). There were three post-operative complications (7.0%): one pneumonia, one pleural effusion, and one diaphragmatic paralysis (need for plication). Results were compared to recent literature, and morbidity and conversion rate were comparable to reviewed publications. Conclusion: VATS represents a valuable tool for diagnostic and therapeutic procedures in pediatric oncology. Nonetheless, it is a challenging technique that should be performed by expert surgeons on oncological and mini-invasive surgery. Three-dimensional reconstruction can optimize the pre-operative planning and guarantee a safer and more targeted treatment. Finally, the advent of robotics-assisted surgery represents a new challenge that may further implement the advantages of VATS.
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Affiliation(s)
- Giovanna Riccipetitoni
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Mirko Bertozzi
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Marta Gazzaneo
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Alessandro Raffaele
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Fabrizio Vatta
- Department of Pediatric Surgery, Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, University of Pavia, Pavia, Italy
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4
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Bouty A, Blanc T, Leclair MD, Lavrand F, Faure A, Binet A, Rod J, O'Brien M, Sarnacki S, Nightingale M, Heloury Y, Varlet F, Scalabre A. Minimally invasive surgery for unilateral Wilms tumors: Multicenter retrospective analysis of 50 transperitoneal laparoscopic total nephrectomies. Pediatr Blood Cancer 2020; 67:e28212. [PMID: 32064752 DOI: 10.1002/pbc.28212] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/18/2019] [Accepted: 01/23/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate feasibility and outcomes of minimally invasive surgery (MIS) in Wilms tumor (WT). METHODS International multicenter review of MIS total nephrectomies for WT between 2006 and 2018. Medical records of confirmed WT were retrospectively assessed for demographic, imaging, treatment, pathology, and oncological outcome data. RESULTS Fifty patients, with a median age of 38 months (6-181), were included in 10 centers. All patients received neoadjuvant chemotherapy, as per SIOP protocol. Median tumor volume post-chemotherapy was 673 mL (18-3331), 16 tumors crossed the lateral border of the spine, and three crossed the midline. Six patients with tumors that crossed the lateral border of the spine (tumor volumes 1560 mL [299-2480]) were converted to an open approach. There was no intraoperative tumor rupture. Overall, MIS was completed in 19% of the 195 nephrectomies for WT presenting during the study period. Tumor was stage I in 29, II in 16, and III in 5, and histology was reported as low in three, intermediate in 42, and high risk in five. Three patients had positive tumor margins. After a median follow-up of 34 months (2-138), there were two local recurrences (both stage I, intermediate risk, 7 and 9 months after surgery) and one metastatic relapse (stage III, high risk, four months after surgery). The three-year event-free survival was 94%. CONCLUSION MIS is feasible in 20% of WT, with oncological outcomes comparable with open surgery, no intraoperative rupture, and a low rate of local relapse. Ongoing surveillance is, however, needed to evaluate this technique as it becomes widespread.
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Affiliation(s)
- Aurore Bouty
- Paediatric Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Thomas Blanc
- Paediatric Surgery Department, Hopital Necker Enfants Malades, Paris, France
| | - Marc David Leclair
- Paediatric Surgery Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Frederic Lavrand
- Paediatric Surgery Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Alice Faure
- Paediatric Surgery Department, Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - Aurelien Binet
- Paediatric Surgery Department, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Julien Rod
- Paediatric Surgery Department, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Mike O'Brien
- Paediatric Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sabine Sarnacki
- Paediatric Surgery Department, Hopital Necker Enfants Malades, Paris, France
| | - Michael Nightingale
- Paediatric Surgery Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Yves Heloury
- Paediatric Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Francois Varlet
- Paediatric Surgery Department, Centre Hospitalier Universitaire, Saint-Etienne, France
| | - Aurelien Scalabre
- Paediatric Surgery Department, Centre Hospitalier Universitaire, Saint-Etienne, France
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5
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Abdelhafeez A, Ortega-Laureano L, Murphy AJ, Davidoff AM, Fernandez-Pineda I, Sandoval JA. Minimally Invasive Surgery in Pediatric Surgical Oncology: Practice Evolution at a Contemporary Single-Center Institution and a Guideline Proposal for a Randomized Controlled Study. J Laparoendosc Adv Surg Tech A 2019; 29:1046-1051. [PMID: 31241404 DOI: 10.1089/lap.2018.0467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Despite the lack of randomized or controlled trials for minimally invasive surgery (MIS) in pediatric surgical oncology, the integration of MIS into the surgical practice of pediatric oncology has become increasingly popular. The aim of this study was to evaluate the implementation of MIS in a pediatric tertiary cancer center and compare present use of MIS to that in a previous analysis at our center. Methods: We retrospectively reviewed the medical records of patients with pediatric cancer treated with MIS at a single institution between 2000 and 2014. Results: A total of 252 MIS procedures were performed: 73 laparoscopic (29%) and 179 thoracoscopic (71%). MIS was used for diagnostic purposes in 59% (146 thoracoscopic and 34 laparoscopic) and the therapeutic resection in 24% (39 laparoscopic cases and 33 thoracoscopic cases). Conversion to an open procedure occurred in 18 tumor resections (6%) and in 22 diagnostic biopsies (7%), mostly due to technical challenges in identifying or mobilizing tumors. Complications occurred in seven tumor resections (2%) and included three pneumothoraces, two bleeding complications, one bowel injury, and one wound infection. Complications occurred in 10 diagnostic biopsies (3%), mostly pneumothoraces. No tumor upstaging or trocar site recurrences occurred (follow-up time, 1-15 years). Conclusions: Over the last decade, we demonstrate the evolution of MIS in the management of solid tumors in children. We encourage surgeons and oncologists to join the call to arms to establish prospective trials evaluating MIS in pediatric surgical oncology.
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Affiliation(s)
| | | | - Andrew J Murphy
- 1Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew M Davidoff
- 1Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - John A Sandoval
- 1Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
- 2HSHS Medical Group Pediatric Surgery, St. John's Children's Hospital, Springfield, Illinois
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6
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Schmidt A, Warmann SW, Urla C, Schaefer J, Fideler F, Fuchs J. Patient selection and technical aspects for laparoscopic nephrectomy in Wilms tumor. Surg Oncol 2019; 29:14-19. [DOI: 10.1016/j.suronc.2019.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/18/2019] [Accepted: 02/11/2019] [Indexed: 12/29/2022]
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7
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Phelps HM, Lovvorn HN. Minimally Invasive Surgery in Pediatric Surgical Oncology. CHILDREN-BASEL 2018; 5:children5120158. [PMID: 30486309 PMCID: PMC6306705 DOI: 10.3390/children5120158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/13/2018] [Accepted: 11/22/2018] [Indexed: 02/06/2023]
Abstract
The application of minimally invasive surgery (MIS) to resect pediatric solid tumors offers the potential for reduced postoperative morbidity with smaller wounds, less pain, fewer surgical site infections, decreased blood loss, shorter hospital stays, and less disruption to treatment regimens. However, significant controversy surrounds the question of whether a high-fidelity oncologic resection of childhood cancers can be achieved through MIS. This review outlines the diverse applications of MIS to treat pediatric malignancies, up to and including definitive resection. This work further summarizes the current evidence supporting the efficacy of MIS to accomplish a definitive, oncologic resection as well as appropriate patient selection criteria for the minimally invasive approach.
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Affiliation(s)
- Hannah M Phelps
- School of Medicine, Vanderbilt University, Nashville, TN 37232, USA.
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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8
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Christison-Lagay ER, Thomas D. Minimally Invasive Approaches to Pediatric Solid Tumors. Surg Oncol Clin N Am 2018; 28:129-146. [PMID: 30414678 DOI: 10.1016/j.soc.2018.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Over the last decade, driven in part by the favorable adult experience and a crescendoing number of case series and retrospective reports in the pediatric surgical literature, minimally invasive surgical (MIS) approaches are increasingly used as adjunctive or definitive surgical treatments for an ever-expanding list of pediatric tumors. Although most current treatment protocols lack surgical guidelines regarding the use of MIS, this growing body of MIS literature provides a framework for the development of multicenter trial groups, prospective registries, and further centralization of subspecialist services. This article highlights the current available data on MIS approaches to a variety of pediatric malignancies.
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Affiliation(s)
- Emily R Christison-Lagay
- Department of Surgery, Section of Pediatric Surgery, Yale School of Medicine, PO Box 208062, New Haven, CT 06520, USA.
| | - Daniel Thomas
- Department of Surgery, Yale School of Medicine, 330 Cedar Street, FMB 107, New Haven, CT 06520, USA
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9
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Maas C, Lüftinger R, Krois W, Matthes-Martin S, Bayer G, Boztug K, Metzelder M. EBV-positive B-cell lymphoma manifestation of the liver in an infant with RAG1 severe combined immunodeficiency disease. Pediatr Blood Cancer 2018; 65:e27258. [PMID: 29856523 DOI: 10.1002/pbc.27258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Constantin Maas
- Department of Pediatric Surgery, Medical University of Vienna, Vienna, Austria
| | - Roswitha Lüftinger
- Department of Pediatrics, St. Anna Kinderspital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria.,Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Wilfried Krois
- Department of Pediatric Surgery, Medical University of Vienna, Vienna, Austria
| | - Susanne Matthes-Martin
- Department of Pediatrics, St. Anna Kinderspital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria.,Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Guenther Bayer
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Kaan Boztug
- Department of Pediatrics, St. Anna Kinderspital and Children's Cancer Research Institute, Medical University of Vienna, Vienna, Austria.,Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria.,CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Martin Metzelder
- Department of Pediatric Surgery, Medical University of Vienna, Vienna, Austria
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10
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Phelps HM, Ayers GD, Ndolo JM, Dietrich HL, Watson KD, Hilmes MA, Lovvorn HN. Maintaining oncologic integrity with minimally invasive resection of pediatric embryonal tumors. Surgery 2018; 164:333-343. [PMID: 29751968 DOI: 10.1016/j.surg.2018.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 03/05/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Embryonal tumors arise typically in infants and young children and are often massive at presentation. Operative resection is a cornerstone in the multimodal treatment of embryonal tumors but potentially disrupts therapeutic timelines. When used appropriately, minimally invasive surgery can minimize treatment delays. The oncologic integrity and safety attainable with minimally invasive resection of embryonal tumors, however, remains controversial. METHODS Query of the Vanderbilt Cancer Registry identified all children treated for intracavitary, embryonal tumors during a 15-year period. Tumors were assessed radiographically to measure volume (mL) and image-defined risk factors (neuroblastic tumors only) at time of diagnosis, and at preresection and postresection. Patient and tumor characteristics, perioperative details, and oncologic outcomes were compared between minimally invasive surgery and open resection of tumors of comparable size. RESULTS A total of 202 patients were treated for 206 intracavitary embryonal tumors, of which 178 were resected either open (n = 152, 85%) or with minimally invasive surgery (n = 26, 15%). The 5-year, relapse-free, and overall survival were not significantly different after minimally invasive surgery or open resection of tumors having a volume less than 100 mL, corresponding to the largest resected with minimally invasive surgery (P = .249 and P = .124, respectively). No difference in margin status or lymph node sampling between the 2 operative approaches was detected (p = .333 and p = .070, respectively). Advantages associated with minimally invasive surgery were decreased blood loss (P < .001), decreased operating time (P = .002), and shorter hospital stay (P < .001). Characteristically, minimally invasive surgery was used for smaller volume and earlier stage neuroblastic tumors without image-defined risk factors. CONCLUSION When selected appropriately, minimally invasive resection of pediatric embryonal tumors, particularly neuroblastic tumors, provides acceptable oncologic integrity. Large tumor volume, small patient size, and image-defined risk factors may limit the broader applicability of minimally invasive surgery.
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Affiliation(s)
- Hannah M Phelps
- Vanderbilt University School of Medicine, Nashville, TN, USA; Surgical Outcomes Center for Kids, Vanderbilt University, Nashville, TN, USA.
| | - Gregory D Ayers
- Division of Cancer Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Josephine M Ndolo
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Katherine D Watson
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melissa A Hilmes
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harold N Lovvorn
- Surgical Outcomes Center for Kids, Vanderbilt University, Nashville, TN, USA; Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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11
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Complications of Minimally Invasive Surgery in Children: A Prospective Morbidity and Mortality Analysis Using the Clavien-Dindo Classification. Surg Laparosc Endosc Percutan Tech 2018; 27:170-174. [PMID: 28414701 DOI: 10.1097/sle.0000000000000401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is a lack of information about evaluation of pediatric minimal access surgery complications; the Clavien-Dindo classification was never used for a large series of laparoscopic and thoracoscopic pediatric procedures. With a prospective Morbidity and Mortality database, all the minimal access surgical procedures carried out between 2012 and 2016 were included in this study. Statistical analyses were used to valuate modification of surgical techniques in to 2 periods (period 1: January 2012 to February 2014; period 2: February 2014 to February 2016). A total of 1374 minimal access procedures were performed on 1371 patients. The overall complication rate was 2.9%. No differences, in terms of complications, were observed between elective and emergency procedures (P=0.3). There was a significant difference between the complication rate of thoracoscopic surgery (P=0.027). These results provide the relevance of adequate recording system and standardized classification for analyses and reduction of complications for pediatric minimal access procedures.
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12
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VanHouwelingen LT, Seims AD, Ortega-Laureano L, Coleman JL, McCarville MB, Davidoff AM, Fernandez-Pineda I. Use of ultrasound in diagnosing postoperative small-bowel intussusception in pediatric surgical oncology patients: a single-center retrospective review. Pediatr Radiol 2018; 48:204-209. [PMID: 29085966 DOI: 10.1007/s00247-017-4018-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/19/2017] [Accepted: 10/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative intussusception can be a complication of abdominal surgery and often poses a diagnostic dilemma. OBJECTIVE The purpose of this study was to evaluate the utility of ultrasonography in the diagnosis of intussusception in children who had recently undergone resection of a primary solid tumor. MATERIALS AND METHODS We performed a retrospective review of all pediatric surgical oncology patients undergoing laparotomy for excision of an abdominal tumor at our institution from 1995 to 2015. We reviewed those with documented postoperative intussusception. In addition we searched the radiology database for all ultrasound examinations requested to rule out postoperative intussusception during our study interval. We analyzed demographics, primary diagnosis, surgical procedure, presentation, diagnostic investigations and definitive treatment. RESULTS At our institution 852 laparotomies for abdominal tumor resection were performed during the study period, resulting in 10 postoperative intussusceptions (1.2% of cases), of which half were following neuroblastoma resection and the other half following nephrectomy for Wilms tumor. Postoperative intussusception was suspected if the patient had increasing nasogastric output, abdominal distension or feeding intolerance. Ultrasound was used to diagnose intussusception in 9/10 cases, on postoperative day 6 (standard deviation [SD] 5.6 days) on average, with a sensitivity of 89% (8/9; one false negative; 95% confidence interval [CI] 0.52, 1.00) and a specificity of 100% (no false positives; 95% CI 0.96, 1.00). CONCLUSION Ultrasound was highly accurate in diagnosing postoperative intussusception in children who underwent resection of retroperitoneal tumors.
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Affiliation(s)
- Lisa T VanHouwelingen
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN, 38105-3678, USA.
| | - Aaron D Seims
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN, 38105-3678, USA
| | - Lucia Ortega-Laureano
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN, 38105-3678, USA
| | - Jamie L Coleman
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mary B McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN, 38105-3678, USA
| | - Israel Fernandez-Pineda
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN, 38105-3678, USA
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13
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Meignan P, Ballouhey Q, Lejeune J, Braik K, Longis B, Cook AR, Lardy H, Fourcade L, Binet A. Robotic-assisted laparoscopic surgery for pediatric tumors: a bicenter experience. J Robot Surg 2017; 12:501-508. [DOI: 10.1007/s11701-017-0773-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022]
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14
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Abstract
Comparative studies and large-scale case series that confirm the advantages of laparoscopy in children with hepatobiliary diseases are scarce, and the use of laparoscopy remains a matter of debate. This article reviews the current literature on the role of laparoscopic and robotic surgery in pediatric patients with choledochal cyst, biliary atresia, gallbladder diseases, and hepatobiliary malignancies. Studies were identified through a search of the MEDLINE database. Laparoscopy may be beneficial for resection of choledochal cyst and cholecystectomy. However, more data are required before recommendations on the use of minimally invasive techniques for other hepatobiliary conditions can be published.
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Affiliation(s)
- Omid Madadi-Sanjani
- Centre of Pediatric Surgery Hannover, Hannover Medical School, Carl-Neuberg-Street 1, Hannover 30625, Germany.
| | - Claus Petersen
- Centre of Pediatric Surgery Hannover, Hannover Medical School, Carl-Neuberg-Street 1, Hannover 30625, Germany
| | - Benno Ure
- Centre of Pediatric Surgery Hannover, Hannover Medical School, Carl-Neuberg-Street 1, Hannover 30625, Germany
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Pediatric oncologic endosurgery. INTERNATIONAL JOURNAL OF SURGERY-ONCOLOGY 2017; 2:e30. [PMID: 29075678 PMCID: PMC5645938 DOI: 10.1097/ij9.0000000000000030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 04/29/2017] [Indexed: 11/26/2022]
Abstract
Despite increasing popularity of minimal-invasive techniques in the pediatric
population, their use in diagnosis and management of pediatric malignancy is still
debated. Moreover, there is limited evidence to clarify this controversy due to low
incidence of each individual type of pediatric tumor, huge diversity of the disease
entity, heterogeneity of surgical technique, and lack of well-designed studies on
pediatric oncologic minimal-invasive surgery. However, a rapid development of medical
instruments and technologies accelerated the current trend toward less invasive
surgery, including oncologic endosurgery. The aim of this article is to review
current literatures about the application of the minimal-invasive approach for
pediatric tumors and to give an overview of the current status, indications,
individual techniques, and future perspectives.
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16
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Minimally invasive resection of adrenal masses in infants and children: results of a European multi-center survey. Surg Endosc 2017; 31:4505-4512. [DOI: 10.1007/s00464-017-5506-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/08/2017] [Indexed: 12/14/2022]
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Shirota C, Tainaka T, Uchida H, Hinoki A, Chiba K, Tanaka Y. Laparoscopic resection of neuroblastomas in low- to high-risk patients without image-defined risk factors is safe and feasible. BMC Pediatr 2017; 17:71. [PMID: 28288594 PMCID: PMC5348921 DOI: 10.1186/s12887-017-0826-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/07/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Several studies have reported that minimally invasive surgery (MIS) might be considered for resecting neuroblastomas without image-defined risk factors (IDRFs); however, there are no studies comparing the outcomes of laparotomy and laparoscopy in IDRF-negative patients. Thus, we investigated the feasibility of laparoscopic surgery and compared the two abovementioned approaches. METHODS To compare the effects of laparotomy with those of laparoscopy in patients with neuroblastomas without IDRFs, the following items were retrospectively compared: largest tumor dimension, volume of blood loss, time required to initiate postoperative feeding, locoregional recurrence rate, survival, etc. RESULTS Nine patients without IDRFs (three at low-to-medium risk and six at high risk) underwent laparotomy, and seven patients without IDRFs (two at low-to-medium risk and five at high risk) underwent laparoscopy. Median duration of surgery was 221 (130-304) and 172 (122-253) min in the laparotomy and laparoscopy groups, respectively, showing no significant difference. Median postoperative time required for resuming meal consumption was significantly longer in the laparotomy (4 days; 2-5) group than that in the laparoscopy group (3 days; 2-3; p = 0.023). Median blood loss was significantly higher in the laparotomy group (5 ml/Kg;2.6-16) than that in the laparoscopy group (2.1 ml/Kg;0.1-4.0; P = 0.037). Median follow-up period was 81 (52-94) and 21 (17-28) months, locoregional recurrence rates were 22 and 0% at 1 year, 1-year progression-free survival rates were 78 and 100%, and overall survival rates were 67 and 100% in the laparotomy and laparoscopy groups, respectively, with no significant differences. CONCLUSIONS MIS for the treatment of neuroblastomas without IDRFs in low- to high-risk patients is safe and feasible and does not compromise the treatment outcome.
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Affiliation(s)
- Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahisa Tainaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinari Hinoki
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kosuke Chiba
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Oh C, Youn JK, Han JW, Kim HY, Jung SE. Abdominal tumors in children: Comparison between minimally invasive surgery and traditional open surgery. Medicine (Baltimore) 2016; 95:e5181. [PMID: 27861341 PMCID: PMC5120898 DOI: 10.1097/md.0000000000005181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The use of minimally invasive surgery (MIS) in pediatric patients has been steadily increasing in recent years. However, its use for diagnosing and treating abdominal tumors in children is still limited compared with adults, especially when malignancy is a matter of debate. Here, we describe the experience at our center with pediatric abdominal tumors to show the safety and feasibility of MIS.Based on a retrospective review of patient records, we selected for study those pediatric patients who had undergone diagnostic exploration or curative resection for abdominal tumors at a single center from January 2010 through August 2015.Diagnostic exploration for abdominal tumors was performed in 32 cases and curative resection in 173 cases (205 operations). MIS was performed in 11 cases of diagnostic exploration (34.4%) and 38 cases of curative resection (21.9%). The mean age of the children who underwent MIS was 6.09 ± 5.2 years. With regard to diagnostic exploration, patient characteristics and surgical outcomes were found to be similar for MIS and open surgery. With regard to curative resection, however, the mean age was significantly lower among the patients who underwent open surgery (4.21 ± 4.20 vs 6.02 ± 4.99 for MIS, P = 0.047), and the proportion of malignancies was significantly higher (80% vs 39.4% for MIS, P < 0.001). MIS compared favorably with open surgery with respect to the rate of recurrence (6.7% vs 35.1%, P = 0.035), the rate of intraoperative transfusions (34.2% vs 58.5%, P = 0.01), the median amount of blood transfused (14 vs 22 mL/kg, P = 0.001), and the mean number of hospital days (4.66 ± 2.36 vs 7.21 ± 5.09, P < 0.001). Complication rates did not differ significantly between the MIS and open surgery groups. The operation was converted to open surgery in 3 cases (27.2%) of diagnostic MIS and in 5 cases (13.1%) of curative MIS.MIS was found to be both feasible and effective for the diagnosis and curative treatment of pediatric abdominal tumors. However, to determine the surgical role and guidelines for MIS for each specific tumor, a multicenter prospective study with a long-term follow-up is warranted.
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Orofino A, Maggipinto C, Lanzillotto M, D'Amato M, Ronzini M, Paradies G. Laparoscopic treatment of adrenal masses in children: Report of two cases and review of literature. Afr J Paediatr Surg 2016; 13:98-102. [PMID: 27251661 PMCID: PMC4955444 DOI: 10.4103/0189-6725.182565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Laparoscopic adrenalectomy has become a common alternative to open surgery for the resection of adrenal lesions in adults: The advantages are to provide better exposure of the adrenal gland, diminish soft tissue dissection, decrease morbidity and postoperative pain; however, reporting on the laparoscopic adrenalectomy in paediatric patients has been limited. We present two cases of laparoscopic adrenalectomy performed at our institution in two children, for left adrenal neuroblastoma in a first patient with opsomyoclonus syndrome, and for a right incidentaloma in the second case. According to recent literature, our experience has demonstrated that the laparoscopic adrenalectomy is a feasible procedure in children with small, well-circumscribed adrenal masses: It can be used a safety to treat suspected benign and malignant adrenal masses in children, with minimal morbidity and short hospital stay. The lateral trans-peritoneal approach offers optimal visualisation and good outcomes in terms of minimal discomfort, rapid recovery and excellent cosmesis. However, in the paediatric field, the number of patients is limited, making the learning curve longer.
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Affiliation(s)
- Antonio Orofino
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
| | - Cosetta Maggipinto
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
| | - MariaPaola Lanzillotto
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
| | - Michele D'Amato
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
| | - Massimo Ronzini
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
| | - Guglielmo Paradies
- Department of Science and Pediatric Surgery, Operative Unit of Pediatric Surgery, Policlinico-Giovanni XXIII University Hospital, Bari, Italy
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20
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Pentek F, Schulte JH, Schweiger B, Metzelder M, Schündeln MM. Development of Port-Site Metastases Following Thoracoscopic Resection of a Neuroblastoma. Pediatr Blood Cancer 2016. [PMID: 26206749 DOI: 10.1002/pbc.25677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report a 26-month-old female who developed port-site metastases of a neuroblastoma following minimally invasive thoracoscopic interventions. After diagnosis of an intrathoracic low-risk neuroblastoma and 6 months of observation, she developed respiratory problems. She subsequently underwent total resection of a locally progressive tumor via thoracoscopy. Six months later, she developed local relapse and subcutaneous metastases within the thoracic wall. These port-site metastases were most likely iatrogenic. After excision of metastases, the residual tumor responded well to salvage chemotherapy. The patient has remained in remission for over 4 years.
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Affiliation(s)
- Falk Pentek
- Department of Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Johannes H Schulte
- Department of Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.,Charité Universitätsmedizin, Department of Pediatrics, Division of Oncology and Hematology, Berlin, Germany.,German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany.,Translational Neuro-Oncology, West German Cancer Center (WTZ), University Hospital Essen, Essen, Germany
| | - Bernd Schweiger
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Martin Metzelder
- Division of Pediatric Surgery, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany.,Department of Pediatric Surgery, Medical University Vienna, Vienna, Austria
| | - Michael M Schündeln
- Department of Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
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Abstract
During recent years, minimally invasive surgery (MIS) has become the standard approach for various operations in infants and children. MIS in pediatric thoracic and abdominal tumors is a controversial approach in the surgical management of childhood cancer. Meanwhile, more and more oncological biopsies and resections are being performed laparoscopically or thoracoscopically. Despite its increasing role in pediatric tumor surgery, the different national and international multicenter trial groups have not yet implemented MIS within guidelines and recommendations in most of the current treatment protocols. An increasing number of retrospective reports describes a potential role of MIS in the management of different pediatric oncological entities. Over the time, there has been a diverse development of this approach with regard to the different neoplasms. Nevertheless, there is a lack of prospective randomized trails assessing MIS. This still represents a requirement for evidence-based medicine and judging the advantages and disadvantages of this approach. The purpose of this state-of-the-art article is to review the current literature to describe the application of MIS in pediatric solid tumors.
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Affiliation(s)
- Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany,
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22
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van Dalen EC, de Lijster MS, Leijssen LGJ, Michiels EMC, Kremer LCM, Caron HN, Aronson DC. Minimally invasive surgery versus open surgery for the treatment of solid abdominal and thoracic neoplasms in children. Cochrane Database Syst Rev 2015; 1:CD008403. [PMID: 25560834 PMCID: PMC7180085 DOI: 10.1002/14651858.cd008403.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is an accepted surgical technique for the treatment of a variety of benign diseases. Presently, the use of MIS in patients with cancer is progressing. However, the role of MIS in children with solid neoplasms is less clear than it is in adults. Although the use of diagnostic MIS to obtain biopsy specimens for pathology is accepted in paediatric surgical oncology, there is limited evidence to support the use of MIS for the resection of malignancies. This review is the second update of a previously published Cochrane review. OBJECTIVES To ascertain differences in outcome between the minimally invasive and open surgical approaches for the treatment of solid intra-abdominal or intra-thoracic neoplasms in children. The primary outcomes of interest are OS, EFS, port-site metastases and recurrence rate; the secondary outcome of interest is surgical morbidity. SEARCH METHODS We searched CENTRAL (The Cochrane Library 2014, Issue 1), MEDLINE/PubMed (from 1966 to February 2014) and EMBASE/Ovid (from 1980 to February 2014) to identify relevant studies. In addition, we searched reference lists of relevant articles and reviews and the conference proceedings of the International Society for Paediatric Oncology and the American Society of Clinical Oncology from 2003 to 2013. On 1 May 2014 we scanned the ISRCTN Register (on www.controlled-trials.com), the National Institutes of Health register (on www.controlled-trials.com and www.clinicaltrials.gov) and the World Health Organization International Clinical Trials Registry Platform (on www.apps.who.int/trialsearch) for ongoing trials. SELECTION CRITERIA Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) comparing MIS to open surgery for the treatment of solid intra-thoracic or intra-abdominal neoplasms in children (aged 0 to 18 years) were considered for inclusion. DATA COLLECTION AND ANALYSIS Two authors performed the study selection independently. MAIN RESULTS The literature search retrieved 542 references. After screening the titles and abstracts we excluded 534 references which clearly did not meet the inclusion criteria. We assessed eight full text studies for eligibility and all of these studies were excluded from the review because they were not RCTs or CCTs. These excluded studies included case series, retrospective chart reviews and retrospective cohort studies. The scanning of reference lists and conference proceedings did not identify any additional studies and no (ongoing trials) were identified by the searches of trial registries. No studies that met the inclusion criteria of this review were identified AUTHORS' CONCLUSIONS No RCTs or CCTs evaluating MIS for the treatment of solid intra-thoracic or intra-abdominal neoplasms in children could be identified. The current evidence base informing the use of MIS in children with solid abdominal and thoracic neoplasms is based on other study designs like case reports, retrospective chart reviews and cohort studies and should be interpreted with caution. Thus there is insufficient evidence to allow any definitive conclusions regarding the use of MIS in these patients. High quality RCTs comparing MIS to open surgery are required. To accomplish this, centres specialising in MIS in children should collaborate.
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Affiliation(s)
- Elvira C van Dalen
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyPO Box 22660 (room TKsO‐247)AmsterdamNetherlands1100 DD
| | | | | | - Erna MC Michiels
- Erasmus MC ‐ Sophia Children's HospitalDepartment of Paediatric OncologyPO Box 2060RotterdamNetherlands3000 CB
| | - Leontien CM Kremer
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyPO Box 22660 (room TKsO‐247)AmsterdamNetherlands1100 DD
| | - Huib N Caron
- Emma Children's Hospital/Academic Medical CenterDepartment of Paediatric OncologyPO Box 22660 (room TKsO‐247)AmsterdamNetherlands1100 DD
| | - Daniel C Aronson
- Queen Elisabeth Central Hospital, College of Medicine, University of MalawiDepartement of Surgery, Division of Paediatric SurgeryBlantyreMalawi
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23
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Malkan AD, Loh AH, Fernandez-Pineda I, Sandoval JA. The Role of Thoracoscopic Surgery in Pediatric Oncology. J Laparoendosc Adv Surg Tech A 2014; 24:819-26. [DOI: 10.1089/lap.2014.0252] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alpin D. Malkan
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amos H.P. Loh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - John A. Sandoval
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
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24
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Duarte RJ, Cristofani LM, Dénes FT, Filho VO, Tannuri U, Srougi M. Wilms Tumor: A Retrospective Study of 32 Patients Using Videolaparoscopic and Open Approaches. Urology 2014; 84:191-5. [DOI: 10.1016/j.urology.2014.02.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 01/26/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
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25
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Malkan AD, Loh AHP, Sandoval JA. Minimally invasive surgery in the management of abdominal tumors in children. J Pediatr Surg 2014; 49:1171-6. [PMID: 24952811 DOI: 10.1016/j.jpedsurg.2014.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 04/03/2014] [Accepted: 04/16/2014] [Indexed: 11/26/2022]
Abstract
The application of minimally invasive surgical techniques to pediatric abdominal tumors is a controversial application towards the surgical management of childhood cancer. Although general pediatric surgeons practice minimally invasive surgery techniques in a vast array of abdominal cases, its role in pediatric oncology is still developing, with no consensus in North America about its use for pediatric solid abdominal tumors. The purposes of this article are to review the current literature about the use of minimally invasive surgery in pediatric abdominal oncology and to examine established indications, procedures and technologic advances.
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Affiliation(s)
- Alpin D Malkan
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Amos H P Loh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - John A Sandoval
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.
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26
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Mattioli G, Avanzini S, Pini Prato A, Pio L, Granata C, Garaventa A, Conte M, Manzitti C, Montobbio G, Buffa P. Laparoscopic resection of adrenal neuroblastoma without image-defined risk factors: a prospective study on 21 consecutive pediatric patients. Pediatr Surg Int 2014; 30:387-94. [PMID: 24477777 DOI: 10.1007/s00383-014-3476-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Over the last 20 years MIS has progressively gained popularity in children with cancer. We therefore aimed at evaluating the safety of Minimally Invasive Surgery (MIS) resection in a series of children affected by adrenal neuroblastoma (NB) presenting without Image-Defined Risk Factors (IDRFs). METHODS An Institutional protocol for MIS resection of adrenal NB in pediatric patients without IDRFs has been applied since 2008. Absence of IDRFs represented the main indication for MIS in NB, regardless of tumor size. All pediatric patients who underwent MIS for NB between January 2008 and May 2013 were included. Specific technical considerations, demographic data, and outcome have been recorded. RESULTS Twenty-one patients underwent MIS resection for IDRFs-negative adrenal NB. Nine of these patients experienced preoperative downgrading of IDRFs after chemotherapy. Radiological median diameter of the mass was 30 mm (range 10-83 mm). Median operative time was 90 min. Median hospital stay was 4 days. All patients were treated successfully, without serious intraoperative complications. One mild intraoperative hemorrhage occurred and was treated without the need for conversion to open surgery nor blood transfusion was required. No postoperative complications, including port-site or peritoneal metastases were experienced. CONCLUSIONS This study demonstrated the safety and effectiveness of MIS for the resection of adrenal NB without IDRFs in children. Pediatric surgeons dedicated to oncology should be aware of this alternative approach to open resection.
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Affiliation(s)
- Girolamo Mattioli
- Pediatric Surgery Department, G. Gaslini Children's Hospital and DINOGMI University of Genoa, Largo G. Gaslini 5, 16147, Genoa, Italy,
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27
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Duarte RJ, Dénes FT, Cristofani LM, Srougi M. Laparoscopic nephrectomy for Wilms’ tumor. Expert Rev Anticancer Ther 2014; 9:753-61. [DOI: 10.1586/era.09.44] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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28
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Fuchs J, Schafbuch L, Ebinger M, Schäfer JF, Seitz G, Warmann SW. Minimally invasive surgery for pediatric tumors - current state of the art. Front Pediatr 2014; 2:48. [PMID: 24918096 PMCID: PMC4042474 DOI: 10.3389/fped.2014.00048] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/14/2014] [Indexed: 12/29/2022] Open
Abstract
During recent years, minimally invasive surgery (MIS) has become the standard approach for various operations in infants and children. This also holds true for surgery in children with solid tumors. Meanwhile, more and more oncological biopsies and resections are being performed laparoscopically or thoracoscopically. Despite its increasing role in pediatric tumor surgery, the different national and international multicenter trial groups have not yet implemented MIS within guidelines and recommendations in most of the current treatment protocols. An increasing number of reports describe a potential role of MIS in the different entities of pediatric surgical oncology. Over the time, there has been a diverse development of this approach with regard to the different neoplasms. The aim of this article is to give an overview and to describe the current state of the art of MIS in pediatric solid tumors.
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Affiliation(s)
- Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen , Tübingen , Germany
| | - Luana Schafbuch
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen , Tübingen , Germany
| | - Martin Ebinger
- Department of Pediatric Oncology, University Children's Hospital Tübingen , Tübingen , Germany
| | - Jürgen F Schäfer
- Department of Clinical and Interventional Radiology, University Children's Hospital Tübingen , Tübingen , Germany
| | - Guido Seitz
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen , Tübingen , Germany
| | - Steven W Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen , Tübingen , Germany
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29
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Ure B. Enthusiasm, evidence and ethics: the triple E of minimally invasive pediatric surgery. J Pediatr Surg 2013; 48:27-33. [PMID: 23331789 DOI: 10.1016/j.jpedsurg.2012.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/13/2012] [Indexed: 12/16/2022]
Abstract
Minimally invasive techniques are applicable in more than 60% of abdominal and thoracic operations in children. Enthusiasts promoted these techniques for many years. However, level 1 evidence on advantages of minimally invasive surgery in children remains limited. Randomized controlled trials have been conducted for some types of procedures such as laparoscopic appendectomy, fundoplication, pyloromyotomy, and inguinal hernia repair. The results of these studies confirm some advantages of minimally invasive surgery, but for most types of laparoscopic and all types of thoracoscopic procedures, such data remain to be established. This article also focuses on reports on complications and disadvantages which are relevant for final conclusions and recommendations. The ethical implications of the application of new techniques in children are also discussed. On the basis of evidence based data and ethical principles, minimally invasive techniques may be appropriately used in the future.
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Affiliation(s)
- Benno Ure
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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30
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Dingemann J, Kuebler JF, Ure BM. Laparoscopic and computer-assisted surgery in children. Scand J Surg 2012; 100:236-42. [PMID: 22182844 DOI: 10.1177/145749691110000402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J Dingemann
- Centre of Pediatric Surgery Hannover, Hannover Medical School and Bult Children's Hospital, Hannover, Germany
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31
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England RJ, Pillay K, Davidson A, Numanoglu A, Millar AJW. Intussusception as a presenting feature of Burkitt lymphoma: implications for management and outcome. Pediatr Surg Int 2012; 28:267-70. [PMID: 21969235 DOI: 10.1007/s00383-011-2982-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2011] [Indexed: 02/07/2023]
Abstract
PURPOSE Intussusception is a recognised but unusual presenting feature of Burkitt lymphoma. We sought to identify the clinical features associated with intussusception in this setting, and assess the outcome following protocol directed chemotherapy. METHODS A retrospective case note review was performed on patients treated for Burkitt lymphoma at our institution between 1976 and 2010. Cases presenting with intussusception were identified from hospital records and oncology database. RESULTS Fourteen of the 210 children seen with a diagnosis of Burkitt lymphoma during the study period (6.7%) developed intussusception. Median age was 6.1 years (range 2.5-10.9). Twelve patients presented with recurrent abdominal pain, and two patients with a jaw mass associated with endemic Burkitt lymphoma. Nine patients underwent a right hemicolectomy with ileo-colic anastomosis, and five had segmental small-bowel resections. Three patients had bone marrow involvement at diagnosis, two of whom died. All patients received chemotherapy. Median follow-up was 6.07 years (range 0.1-28.8). CONCLUSIONS Small bowel lymphoma should be considered in children presenting with intussusception above the normal infantile peak age range. The presentation is often insidious, and complete obstruction may not be apparent. However, when surgically resected, the majority can achieve a good outcome with additional chemotherapy.
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Affiliation(s)
- R J England
- Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.
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32
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de Lijster MS, Bergevoet RM, van Dalen EC, Michiels EMC, Caron HN, Kremer LCM, Aronson DC. Minimally invasive surgery versus open surgery for the treatment of solid abdominal and thoracic neoplasms in children. Cochrane Database Syst Rev 2012; 1:CD008403. [PMID: 22258984 DOI: 10.1002/14651858.cd008403.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is an accepted surgical technique for the treatment of a variety of benign diseases. Presently, the use of MIS in patients with cancer is progressing. However, the role of MIS in children with solid neoplasms is less clear than it is in adults. Diagnostic MIS to obtain biopsy specimens for pathology has been accepted as a technique in paediatric surgical oncology, but there is limited experience with the use of MIS for the resection of malignancies. OBJECTIVES To ascertain the differences in outcome between the minimally invasive and open approach in the treatment of solid intra-thoracic and intra-abdominal neoplasms in children, regarding overall survival, event-free survival, port-site metastases, recurrence rate and surgical morbidity. SEARCH METHODS We searched the electronic databases of MEDLINE/PubMed (from 1966 to February 2011), EMBASE/Ovid (from 1980 to February 2011) and CENTRAL (The Cochrane Library 2011, Issue 1) with pre-specified terms. In addition, we searched reference lists of relevant articles and reviews, conference proceedings and ongoing trial databases. SELECTION CRITERIA Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) comparing MIS and open surgery for the treatment of solid intra-thoracic or intra-abdominal neoplasms in children (aged 0 to 18 years). DATA COLLECTION AND ANALYSIS Two authors performed the study selection independently. MAIN RESULTS No studies that met the inclusion criteria of this review were identified. AUTHORS' CONCLUSIONS No RCTs or CCTs evaluating MIS in the treatment of solid intra-thoracic or intra-abdominal neoplasms in children could be identified, therefore no definitive conclusions could be made about the effects of MIS in these patients. Based on the currently available evidence we are not able to give recommendations for the use of MIS in the treatment of solid intra-thoracic or intra-abdominal neoplasms in children. More high quality studies (RCTs and/or CCTs) are needed. To accomplish this, centres specialising in MIS in children should collaborate.
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Affiliation(s)
- Manou S de Lijster
- Pediatric Surgical Center of Amsterdam, EmmaChildren’sHospital / AcademicMedical Center, Amsterdam,Netherlands
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Metzelder ML, Schober T, Grigull L, Klein C, Kuebler JF, Ure BM, Maecker-Kolhoff B. The Role of Laparoscopic Techniques in Children with Suspected Post-Transplantation Lymphoproliferative Disorders. J Laparoendosc Adv Surg Tech A 2011; 21:767-70. [DOI: 10.1089/lap.2010.0175] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Tilmann Schober
- Department of Pediatric Hematology/Oncology, Hannover Medical School, Hannover, Germany
| | - Lorenz Grigull
- Department of Pediatric Hematology/Oncology, Hannover Medical School, Hannover, Germany
| | - Christoph Klein
- Department of Pediatric Hematology/Oncology, Hannover Medical School, Hannover, Germany
| | - Joachim F. Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Benno M. Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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Bhatnagar S, Sarin YK. Scope and limitations of minimal invasive surgery in practice of pediatric surgical oncology. Indian J Med Paediatr Oncol 2011; 31:137-42. [PMID: 21584219 PMCID: PMC3089922 DOI: 10.4103/0971-5851.76198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Management of Solid tumors in children needs a comprehensive multimodality protocol based treatment plan. Open surgical removal of the tumors occurring in any of the sites such as abdomen, thorax, chest wall, HFN (head, face, neck), brain and extremities, is the option which has been traditionally practiced even in the present era and in most of the centers. Nevertheless with the advances in science and technology and with ever increasing usage and expertise of laparoscopy in children, it's application has extended to treatment of solid tumors in children. A review of the scope of such intervention as well as the limitations of minimal invasive surgery in this specialized field of pediatric surgery has been attempted in this article.
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Affiliation(s)
- Sushmita Bhatnagar
- Department of Pediatric Surgery, B. J. Wadia Hospital for Children, Acharya Donde Marg, Parel, Mumbai - 400 018, India
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Gow KW, Chen MK, Barnhart D, Breuer C, Brown M, Calkins C, Ford H, Harmon C, Hebra A, Kane T, Keshen T, Kokoska ER, Lawlor D, Pearl R. American Pediatric Surgical Association New Technology Committee review on video-assisted thoracoscopic surgery for childhood cancer. J Pediatr Surg 2010; 45:2227-33. [PMID: 21034949 DOI: 10.1016/j.jpedsurg.2010.06.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 06/30/2010] [Accepted: 06/30/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Although the use of minimally invasive surgical (MIS) techniques for children with cancer is being practiced by some, its role remains unclearly defined. The purpose of this review was to describe the current literature on MIS for thoracic and mediastinal lesions in children. METHODS We performed a literature search for English studies that evaluated MIS techniques for biopsy or resection in children with suspected or established cancer. Only studies with greater than 20 patients were included in the review. RESULTS Ten studies were included for review. Each represented institutional retrospective reviews of experience. Seven were single-institution studies, and 3 were multi-institutional. There were no prospective nor randomized identified. CONCLUSIONS Based on primarily retrospective and observational data, the use of MIS for children with cancer who have pulmonary and mediastinal lesions seems to be effective and safe. Ideally, prospective studies are needed to evaluate this further.
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Affiliation(s)
- Kenneth W Gow
- General and Thoracic Surgery, Seattle Children's Hospital, and University of Washington, Seattle WA, USA
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Kim T, Kim DY, Cho MJ, Kim SC, Seo JJ, Kim IK. Use of laparoscopic surgical resection for pediatric malignant solid tumors: a case series. Surg Endosc 2010; 25:1484-8. [DOI: 10.1007/s00464-010-1418-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 08/29/2010] [Indexed: 10/18/2022]
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England RJ, Al-Adnani M, Cohen MC, Godbole PP, Marven SS. Cystoscopy assisted transvesical biopsy of prostatic rhabdomyosarcoma. Pediatr Blood Cancer 2010; 55:583-5. [PMID: 20658638 DOI: 10.1002/pbc.22600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The treatment of prostatic rhabdomyosarcoma (RMS) depends on tumour stratification based on site and histology. An increasing range of cytogenetic, molecular, and immunohistochemistry studies are required. This is difficult to achieve using standard cystoscopic biopsies alone. We present a 5-year-old male, diagnosed with a prostatic RMS. He underwent cystoscopy to confirm the diagnosis and at the same time tissue was obtained for histology using laparoscopic graspers via a STEP Port inserted percutaneously into the apex of his bladder. Histology and cytogenetics confirmed an embryonal botryoid RMS for which he received chemotherapy followed by a radical prostatectomy for residual disease.
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Affiliation(s)
- Richard J England
- Paediatric Surgical Unit, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, UK.
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Abstract
In recent years minimally invasive surgical techniques in children have made substantial progress. The feasibility and safety of a wide spectrum of laparoscopic and thoracoscopic procedures have been confirmed in numerous studies. Moreover, it was reported that minimally invasive pediatric surgery is associated with lower morbidity, a shorter hospital stay, lower costs, better cosmetics and clinical results similar to those achieved by open surgery. The present article reviews information on established as well as feasible but not yet established surgical procedures. The discussion of potential hemodynamic, respiratory and organ perfusion effects of the CO(2) pneumoperitoneum and the notation of special logistic aspects should support the reader in the process of decision-making to schedule infants and children for minimally invasive surgery.
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de Lijster MS, Bergevoet RM, van Dalen EC, Michiels EM, Caron HN, Kremer LC, Aronson DC. Minimally invasive surgery versus open surgery for the treatment of solid abdominal and thoracic neoplasms in children. Cochrane Database Syst Rev 2010:CD008403. [PMID: 20238368 DOI: 10.1002/14651858.cd008403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is an accepted surgical technique for the treatment of a variety of benign diseases. Presently, the use of MIS in patients with cancer is progressing. However, the role of MIS in children with solid neoplasms is less clear than it is in adults. Diagnostic MIS to obtain biopsy specimens for pathology has been accepted as a technique in paediatric surgical oncology, but there is limited experience with the use of MIS for the resection of malignancies. OBJECTIVES To ascertain the differences in outcome between the minimally invasive and open approach in the treatment of solid intra-thoracic and intra-abdominal neoplasms in children, regarding overall survival, event-free survival, port-site metastases, recurrence rate and surgical morbidity. SEARCH STRATEGY We searched the electronic databases of MEDLINE/PubMed (from 1966 to March 2008), EMBASE/Ovid (from 1980 to March 2008) and CENTRAL (The Cochrane Library 2008, Issue 1) with pre-specified terms. In addition, we searched reference lists of relevant articles and reviews, conference proceedings and ongoing trial databases. SELECTION CRITERIA Randomised controlled trials (RCTs) or controlled clinical trials (CCTs) comparing MIS and open surgery for the treatment of solid intra-thoracic or intra-abdominal neoplasms in children (aged 0 to 18 years). DATA COLLECTION AND ANALYSIS Two authors performed the study selection independently. MAIN RESULTS No studies that met the inclusion criteria of this review were identified. AUTHORS' CONCLUSIONS No RCTs or CCTs evaluating MIS in the treatment of solid intra-thoracic or intra-abdominal neoplasms in children could be identified, therefore no definitive conclusions could be made about the effects of MIS in these patients. Based on the currently available evidence we are not able to give recommendations for the use of MIS in the treatment of solid intra-thoracic or intra-abdominal neoplasms in children. More high quality studies (RCTs and/or CCTs) are needed. To accomplish this, centres specialising in MIS in children should collaborate.
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Affiliation(s)
- Manou S de Lijster
- Radiology, Academic Medical Center, PO Box 22660, Amsterdam, Netherlands, 1100 DD
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Yu Y, Kuebler J, Groos S, Metzelder M, Kurpanik S, Ure BM, Vieten G. Carbon dioxide modifies the morphology and function of mesothelial cells and facilitates transepithelial neuroblastoma cell migration. Pediatr Surg Int 2010; 26:29-36. [PMID: 19847444 DOI: 10.1007/s00383-009-2503-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The response of mesothelial cells to surgical trauma and bacterial contamination is poorly defined. We have recently shown that CO(2) pneumoperitoneum increases systemic metastasis of neuroblastoma cells in a murine model. Thus, we hypothesized that CO(2) alters the morphology and function of mesothelial cells and facilitates transmesothelial tumor cell migration. MATERIALS AND METHODS Murine mesothelial cells were exposed to 100% CO(2) and 5% CO(2) as control. Scanning electron microscopy (SEM) investigations, as well as LPS-induced granulocyte-colony stimulating factor (G-CSF) production and mitochondrial activity (MTT assay) were measured. Transmesothelial migration of neuroblastoma cells (Neuro2a) was determined using a transwell chamber system. RESULTS CO(2) incubation was associated with a significant destruction of the microvillar formation in SEM. Migration studies showed that the barrier function of the mesothelial monolayer decreased. A significantly increased migration of neuroblastoma cells was identified after 100% CO(2) exposure (P < 0.05). Although the conversion of MTT as an indicator of mitochondrial activity was only slightly and not significantly reduced after CO(2) incubation, the release of G-CSF induced by LPS was completely blocked during the incubation with 100% CO(2) (P < 0.05). The capacity of G-CSF release recovered after the incubation. CONCLUSION We observed that peritoneal mesothelial cells lose their typical cell morphology by CO(2) incubation, which is accompanied by facilitated migration of neuroblastoma cells. Moreover, the synthesis of immunological factors is blocked, but this effect is not long lasting. These mechanisms may explain an increased metastasis rate of neuroblastoma cells after CO(2) pneumoperitoneum, which was recently observed in a murine model.
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Affiliation(s)
- Yi Yu
- Department of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
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Metzelder ML, Kuebler JF, Reismann M, Lawal TA, Glueer S, Ure B. Prior thoracic surgery has a limited impact on the feasibility of consecutive thoracoscopy in children: a prospective study on 228 procedures. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S63-6. [PMID: 18999977 DOI: 10.1089/lap.2008.0150.supp] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to determine the impact of prior thoracic surgery on consecutive ipsilateral thoracoscopic surgery in children. METHODS We prospectively analyzed 228 thoracic procedures, which were performed in 190 children (99 male,91 female; mean age, 5.1 years; range, 1 day to 18 years) over a 7-year period (January 2000 to August 2007).Of these, 137 were thoracoscopies and 91 conventional operations. A panel of pediatric pulmonologists, anesthetists,and pediatric surgeons decided whether a thoracoscopy or a conventional approach was indicated. The endpoints were conversion rate, intraoperative events, and complications in subsequent thoracoscopies with regard to the type of prior thoracic surgery. In addition, the reasons for exclusion from thorascopy of those patients,who had a previous thoracic operation, should be identified. RESULTS Thirty-two patients (14%) had prior ipsilateral thoracic surgery; 20 of these underwent thoracoscopy,12 after prior thoracotomy and 8 after prior thoracoscopy. The type of initial approach had no significant impact on the conversion rate of subsequent thoracoscopy (1/12 after thoracotomy vs. 0/8 after thoracoscopy; not significant). The conversion rate was not significantly different in patients with or without prior surgery (1/20 vs. 19/117; not significant). However, there was a higher number of reconstructive procedures in patients without prior surgery, which was reflected in conversions due to lack of overview (n 12), bleeding (n 3), tension during reconstruction of a diaphragmatic defect (n 2) and esophageal atresia (n 2), and intraoperative respiratory problems (n 1). Twelve patients with a prior operation underwent thoracotomy due to limited respiratory capacity (n 5), advanced tumor stage, prior sternotomy (n 6), and limited visibility, leading to conversion during initial thoracoscopy (n 1). CONCLUSIONS Prior thoracic operation has, independent of the initial approach, a limited impact on the feasibility of ipsilateral consecutive thoracoscopic surgery in children. The feasibility of thoracoscopy after prior operation is excellent.
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Affiliation(s)
- Martin L Metzelder
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
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Durkin ET, Shaaban AF. Recent advances and controversies in pediatric laparoscopic surgery. Surg Clin North Am 2008; 88:1101-19, viii. [PMID: 18790157 DOI: 10.1016/j.suc.2008.05.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Children represent a unique group of patients who are likely to greatly benefit from minimally invasive surgery (MIS). The promise of less postoperative pain, smaller scars, shorter hospital stays, and a faster return to school continues to drive growth in this area. The development of pediatric-specific techniques and documentation of improved outcomes form a critical gateway to widespread application of pediatric MIS. A brief perspective on current approaches to MIS for pediatric congenital and acquired disease is provided in this report. Technical departures from standardized adult MIS and the rationale for their modification are highlighted.
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Affiliation(s)
- Emily T Durkin
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA
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Metzelder ML, Kuebler JF, Reismann M, Lawal TA, Glueer S, Ure B. Prior thoracic surgery has a limited impact on the feasibility of consecutive thoracoscopy in children: a prospective study on 228 procedures. J Laparoendosc Adv Surg Tech A 2008. [PMID: 18999977 DOI: 10.1089/lap.2008.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to determine the impact of prior thoracic surgery on consecutive ipsilateral thoracoscopic surgery in children. METHODS We prospectively analyzed 228 thoracic procedures, which were performed in 190 children (99 male,91 female; mean age, 5.1 years; range, 1 day to 18 years) over a 7-year period (January 2000 to August 2007).Of these, 137 were thoracoscopies and 91 conventional operations. A panel of pediatric pulmonologists, anesthetists,and pediatric surgeons decided whether a thoracoscopy or a conventional approach was indicated. The endpoints were conversion rate, intraoperative events, and complications in subsequent thoracoscopies with regard to the type of prior thoracic surgery. In addition, the reasons for exclusion from thorascopy of those patients,who had a previous thoracic operation, should be identified. RESULTS Thirty-two patients (14%) had prior ipsilateral thoracic surgery; 20 of these underwent thoracoscopy,12 after prior thoracotomy and 8 after prior thoracoscopy. The type of initial approach had no significant impact on the conversion rate of subsequent thoracoscopy (1/12 after thoracotomy vs. 0/8 after thoracoscopy; not significant). The conversion rate was not significantly different in patients with or without prior surgery (1/20 vs. 19/117; not significant). However, there was a higher number of reconstructive procedures in patients without prior surgery, which was reflected in conversions due to lack of overview (n 12), bleeding (n 3), tension during reconstruction of a diaphragmatic defect (n 2) and esophageal atresia (n 2), and intraoperative respiratory problems (n 1). Twelve patients with a prior operation underwent thoracotomy due to limited respiratory capacity (n 5), advanced tumor stage, prior sternotomy (n 6), and limited visibility, leading to conversion during initial thoracoscopy (n 1). CONCLUSIONS Prior thoracic operation has, independent of the initial approach, a limited impact on the feasibility of ipsilateral consecutive thoracoscopic surgery in children. The feasibility of thoracoscopy after prior operation is excellent.
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Affiliation(s)
- Martin L Metzelder
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
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CO2 pneumoperitoneum increases systemic but not local tumor spread after intraperitoneal murine neuroblastoma spillage in mice. Surg Endosc 2008; 22:2648-53. [DOI: 10.1007/s00464-008-9778-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 10/15/2007] [Indexed: 10/22/2022]
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