Pediatric Robotic Prostatectomy and Pelvic Lymphadenectomy for Embryonal Rhabdomyosarcoma

Radiation-induced Sarcoma of the Prostate After Treatment for Rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is among the most common pediatric solid malignancies. Fusion-negative, embryonal RMS is the predominant histology among prostate and bladder lesions. Management strategies depend on the clinical stage and risk group. Although the optimal strategy continues to evolve, the field has transitioned from radical upfront resection to organ preservation strategies with multi-modal therapy, including chemotherapy, radiation, and surgery. Survivors frequently develop late complications, including impaired fertility and sexual function, bladder dysfunction, and secondary malignancies. Our case describes an 11-year-old male who developed a radiation-induced prostatic sarcoma. We present a novel surgical technique and highlight the importance of multidisciplinary care.

Robotic-assisted Laparoscopic Management of Bladder/Prostate Rhabdomyosarcoma in Children: Initial Series and 1-yr Outcomes

OBJECTIVE

To present our preliminary experiences of robotic-assisted laparoscopic radical or partial cystectomy for bladder/prostate rhabdomyosarcoma in children.

METHODS

A retrospective study was conducted with children who underwent robotic-assisted laparoscopic surgery for bladder/prostate rhabdomyosarcoma (B/P RMS) between July 2018 and March 2020. The patient characteristics, tumor position, perioperative information, short time oncologic survival outcomes, and urinary function were recorded and evaluated.

RESULTS

We identified eight children who underwent robotic-assisted laparoscopic surgery for B/P RMS. Partial cystectomy was performed on all but one patient, who underwent a radical cystectomy and sigmoid neobladder reconstruction. Preoperative chemotherapy was administered to all eight patients, while preoperative radiotherapy was conducted in three cases, including one patient with a history of pelvic rhabdomyosarcoma. Unilateral/bilateral ureter reimplantation was done in four cases in which the patients' ureter orifices were involved. The mean follow-up time was 13.3 months, and no local recurrence or metastasis was observed. No patient experienced urinary incontinence eventually.

CONCLUSION

Robotic-assisted laparoscopic resection for bladder rhabdomyosarcoma in children is safe and feasible. Preoperative radiotherapy could decrease the tumor volume so that the membranous urethra could be preserved for as long as possible. The oncological efficacy and overall survival rate require further investigation and longer follow-up.

Robot-assisted Radical Prostatectomy Due to a Primary Carcinoid Prostatic Tumor in a Three-Year-Old Child: A Case Report

We present an extremely rare case of a 3-year-old child with a primary carcinoid tumor of the prostate. A 3-year-old boy presented with failure to thrive, constipation, recurrent respiratory tract infections, and pain in the genital area. His karyotype was normal and cystic fibrosis and coeliac disease were excluded prior to further investigation. An abdominopelvic computed tomography scan revealed a prostatic mass. Transrectal ultrasound-guided prostate biopsy was therefore performed and pathological examination revealed a carcinoid tumor. A robotic radical prostatectomy was performed. As this is an innovative surgical approach, we describe the surgical technique used.