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McKay KG, Abdul Ghani MO, Crane GL, Evans PT, Zhao S, Martin LY, Thomas JC, Correa H, Benedetti DJ, Lovvorn HN. Oncologic Fidelity of Minimally Invasive Surgery to Resect Neoadjuvant-Treated Wilms Tumors. Am Surg 2022; 88:943-952. [DOI: 10.1177/00031348211070796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The Children's Oncology Group recommends upfront resection of Wilms tumor (WT), however, unique scenarios warrant neoadjuvant chemotherapy and delayed resection. We hypothesized that in the context of neoadjuvant chemotherapy, minimally invasive surgery (MIS) to resect WT achieves equivalent oncologic fidelity and better maintains therapy schedules. Methods A retrospective analysis of WT treated between 2010-2021 at a free-standing children's hospital was performed. Patient and disease specific characteristics were collected, and pre-resection tumor volumes (TV) were calculated. Impact of MIS or open resection on oncologic fidelity and time to resume chemotherapy was analyzed. Results For the study period, 62 patients were treated for 65 WT, and 14 patients (22.6%) received neoadjuvant chemotherapy to treat 17 WT (26.2%): 7 Stage I (all predisposition syndromes), 2 stage III, 7 stage IV, and 1 stage V (bilateral). MIS was utilized to resect 6 WT from 5 patients. For partial nephrectomy, pre-resection TV was 0.38 ml if MIS and 10.38 ml if open ( P = .025). For radical nephrectomy, pre-resection TV was 31.58 ml if MIS and 175.00 ml if open ( P = .101). No significant differences between surgical approach were detected regarding pathologic variables or survival. Epidural use was significantly greater with open procedures ( P = .001). Length of stay was 2.00 days after MIS compared to 6.00 for open resection ( P = .004). Time to resume chemotherapy was 7.00 days after MIS versus 27.00 for open ( P = .004). Conclusion After neoadjuvant chemotherapy for WT, MIS partial and radical nephrectomies achieved equivalent oncologic fidelity, reduced epidural use and post-operative stays, and better maintained adjuvant therapy timelines when compared to open resections.
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Affiliation(s)
- Katlyn G. McKay
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Gabriella L. Crane
- Division of Pediatric Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Parker T. Evans
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shilin Zhao
- Vanderbilt Center for Quantitative Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura Y. Martin
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - John C. Thomas
- Division of Pediatric Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hernan Correa
- Division of Pediatric Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel J. Benedetti
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harold N. Lovvorn
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, USA
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Abstract
The prognosis of children with Wilms tumour has greatly improved since the introduction of adjuvant radiotherapy and chemotherapy more than 70 years ago with a current overall long-term survival approaching 90%. Before this, surgery was the only option with around 20% survival, even in low-risk categories. The focus is now on management options for those patients in specific subgroups, who continue to have lower event-free survival and who suffer from the long-term effects of treatment. These include those with anaplastic histology, bilateral Wilms, biologically high-risk tumours and those that relapse (Aldrink et al. in J Pediatr Surg 54(3):390-397, 2019). The major advances that have already been made in risk assessment and tailoring the chemotherapy/radiotherapy to achieve maximum advantage with minimum toxicity and long-term morbidity have been predicated on safe and complete resection and staging of the tumour. There are, however, still surgical challenges faced with respect to resection of 'complex' tumours; thus, surgeons need to understand their role and advance their expertise in the overall treatment of children with Wilms tumour. These include very large tumours not responding to chemotherapy, ruptured tumours, tumours with intravascular invasion into the inferior vena cava (± 10%), heart and hepatic veins (± 4%) and Wilms tumours in horseshoe kidneys (< 1%) (Kieran and Ehrlich in Urol Oncol https://doi.org/10.1016/j.urolonc.2015.05.029, 2015). This review describes surgical strategies and techniques used in these situations, gleaned from the authors' experience in the surgical management of over 300 children with Wilms tumours in our centres over the last 30 years.
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Affiliation(s)
- Sharon Cox
- Division of Paediatric Surgery, University of Cape Town and Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.
| | - Cenk Büyükünal
- Division of Paediatric Urology, Department of Paediatric Surgery, Cerrahpasa Medical Faculty, University of Istanbul, Istanbul, Turkey
| | - Alastair J W Millar
- Division of Paediatric Surgery, University of Cape Town and Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa
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Le Rouzic MA, Mansuy L, Galloy MA, Champigneulle J, Bernier V, Chastagner P. Agreement between clinicoradiological signs at diagnosis and radiohistological analysis after neoadjuvant chemotherapy of suspected Wilms tumor rupture: Consequences on therapeutic choices. Pediatr Blood Cancer 2019; 66:e27674. [PMID: 30773805 DOI: 10.1002/pbc.27674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION According to SIOP criteria, every patient presenting with preoperative Wilms tumor (WT) rupture must receive abdominal radiotherapy. Neoadjuvant chemotherapy reduces tumor volume and is responsible for the development of peritumoral capsule formation, which can mask tumor rupture on histological analysis, while it was clinically or radiologically obvious at diagnosis. Yet, there are no protocol recommendations for this particular presentation. OBJECTIVES Study the agreement between clinicoradiological signs and histological confirmation after neoadjuvant chemotherapy of suspected WT rupture and describe the therapeutic choices arising in consequence. METHODS Descriptive retrospective study on a monocentric series of patients with WT between June 1991 and August 2017. RESULTS Out of 71 patients, 28 presented with suspected tumor rupture. We observed good agreement between clinical and radiological signs of suspected rupture (κ coefficient: 0.67). However, we assessed poor agreement between these signs and histological conclusions after neoadjuvant chemotherapy (κ coefficient: 0.27). Only five patients with clinicoradiological signs were overtreated with radiotherapy while tumor rupture had been refuted after histological review. The notion of abdominal trauma and the presence of intraperitoneal effusion seemed to guide collegial decision to overtreat these patients. No statistical difference in survival between patients with and without suspicion of tumor rupture at diagnosis was observed. CONCLUSION This study highlights the need for recommendations in case of discrepancy between radiological and histological signs of rupture at diagnosis and after neoadjuvant chemotherapy. A study with stronger statistical power is necessary to define criteria that would lead to optimization of treatment in this context.
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Affiliation(s)
- Marie-Amelyne Le Rouzic
- Department of Pediatric Hematology and Oncology, Children's University Hospital, Nancy, France
| | - Ludovic Mansuy
- Department of Pediatric Hematology and Oncology, Children's University Hospital, Nancy, France
| | - Marie-Agnès Galloy
- Department of Pediatric Radiology, Children's University Hospital, Nancy, France
| | | | - Valérie Bernier
- Department of Radiotherapy, Lorraine Institute of Oncology, Nancy, France
| | - Pascal Chastagner
- Department of Pediatric Hematology and Oncology, Children's University Hospital, Nancy, France
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Flores P, Cadario M, Lenz Y, Cacciavillano W, Galluzzo L, Nestor Paz EG, Corbetta JP, Zubizarreta P. Laparoscopic total nephrectomy for Wilms tumor: Towards new standards of care. J Pediatr Urol 2018; 14:388-393. [PMID: 30049484 DOI: 10.1016/j.jpurol.2018.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/07/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Laparoscopic total nephrectomy (LN) in malignant pediatric tumors remains controversial. For selected patients undergoing pre-operative chemotherapy in referral centers, LN has so far shown comparable results to the standard open technique. PURPOSE To describe the inclusion criteria and preliminary results of laparoscopic nephrectomies (LN) for the treatment of unilateral Wilms tumors (WT). MATERIAL AND METHODS Between November 2010 and January 2016, a retrospective study of patients with WT and undergoing pre-operative chemotherapy was performed. Inclusion criteria for candidates for LN were: unilateral tumors without venous invasion and central kidney localization. Tumor size and vascular thrombus were estimated with pre-operative computed tomography (CT) scan. Overall survival and recurrence rates were evaluated. RESULTS Among 105 patients with WT, 14 underwent LN. Tumor bleeding or the lack of response to chemotherapy were not exclusion criteria. Median tumor volume for the patients undergoing LN was 71.5 cc (range 7-169). Patients with small tumors localized near the renal pole and candidates for nephron sparing surgery (NSS) were excluded. Estimated 5-year overall survival for all patients with WT during this period was 88.7% (88.1-103.1). Two patients underwent conversion. No recurrence or related death was found at a mean 32- month follow-up period. DISCUSSION Reproducing the steps of the open nephrectomy when performing LN for malignant tumors allowed comparable oncologic results to the conventional procedure. However, upstaging of the tumor was not admissible and has become the main goal when approaching these patients laparoscopically. Preliminary results showed that the incidence of intraoperative rupture and incomplete node sampling were not an issue when comparing LN to open nephrectomy. On the other hand, LN for malignant tumors requires experience in advanced laparoscopy and oncologic surgery. Pre-operative chemotherapy changes the tumor's consistency and this is the key point as to why these patients are amenable to be approached laparoscopically. Lifting the tumor along with the fat to avoid capsule fraction, as well as changing the lens to the lateral port to achieve a correct view for lymph node sampling are some of the considerations when performing LN. CONCLUSIONS Preliminary data suggest that LN for WT is feasible and has promising results in terms of event-free and overall survival. In patients undergoing pre-operative chemotherapy the correct selection for LN is crucial. Following the basic oncological precepts and in experienced centers, LN represents a plausible modality in the care of these patients.
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Affiliation(s)
- Paula Flores
- Pediatric Surgery Department, Garrahan Hospital, Buenos Aires, Argentina.
| | - Martín Cadario
- Pediatric Surgery Department, Garrahan Hospital, Buenos Aires, Argentina
| | - Yvonne Lenz
- Pediatric Surgery Department, Garrahan Hospital, Buenos Aires, Argentina
| | - Walter Cacciavillano
- Pediatric Clinical Oncology Department, Garrahan Hospital, Buenos Aires, Argentina
| | - Laura Galluzzo
- Pediatric Pathology Department, Garrahan Hospital, Buenos Aires, Argentina
| | | | | | - Pedro Zubizarreta
- Pediatric Clinical Oncology Department, Garrahan Hospital, Buenos Aires, Argentina
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5
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Ezekian B, Englum BR, Gulack BC, Rialon KL, Kim J, Talbot LJ, Adibe OO, Routh JC, Tracy ET, Rice HE. Comparing oncologic outcomes after minimally invasive and open surgery for pediatric neuroblastoma and Wilms tumor. Pediatr Blood Cancer 2018; 65. [PMID: 28792662 DOI: 10.1002/pbc.26755] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/07/2017] [Accepted: 07/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) has been widely adopted for common operations in pediatric surgery; however, its role in childhood tumors is limited by concerns about oncologic outcomes. We compared open and MIS approaches for pediatric neuroblastoma and Wilms tumor (WT) using a national database. METHODS The National Cancer Data Base from 2010 to 2012 was queried for cases of neuroblastoma and WT in children ≤21 years old. Children were classified as receiving open or MIS surgery for definitive resection, with clinical outcomes compared using a propensity matching methodology (two open:one MIS). RESULTS For children with neuroblastoma, 17% (98 of 579) underwent MIS, while only 5% of children with WT (35 of 695) had an MIS approach for tumor resection. After propensity matching, there was no difference between open and MIS surgery for either tumor for 30-day mortality, readmissions, surgical margin status, and 1- and 3-year survival. However, in both tumors, open surgery more often evaluated lymph nodes and had larger lymph node harvest. CONCLUSION Our retrospective review suggests that the use of MIS appears to be a safe method of oncologic resection for select children with neuroblastoma and WT. Further research should clarify which children are the optimal candidates for this approach.
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Affiliation(s)
- Brian Ezekian
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Brian R Englum
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Brian C Gulack
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Kristy L Rialon
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jina Kim
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Lindsay J Talbot
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Obinna O Adibe
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jonathan C Routh
- Division of Urology, Duke University Medical Center, Durham, North Carolina
| | - Elisabeth T Tracy
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Henry E Rice
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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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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7
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Lorenzo AJ, Romao RLP. The Evolving Role of Minimally Invasive Surgery in Pediatric and Adolescent Urologic Oncology. Urology 2017; 91:180-9. [PMID: 27107196 DOI: 10.1016/j.urology.2015.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/20/2015] [Accepted: 12/14/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This review aims at evaluating the current status of minimally invasive surgery at the difficult crossroad between the attractiveness of innovation faced against the solid outcomes offered by the current gold standard, specifically concerning pediatric and adolescent urologic oncology conditions. METHODS This is a critical review of the literature and current paradigms on the use of minimally invasive surgery for pediatric and adolescent urologic oncology cancers. Focus is mainly on the use of laparoscopy for the treatment of Wilms' tumors but other neoplasms are also discussed. RESULTS We draw parallels with other similar pathologies, respecting critical lessons from international cooperative study groups. We discuss various aspects of the pros and cons of minimally invasive surgery in this patient population and make a case for the development of dedicated pediatric surgeons for urologic cancer. CONCLUSION Herein we draft a proposal suggesting a way forward with the adoption of reasonable paradigm shifts founded on carefully conducted studies for the introduction of minimally invasive surgery in the care of pediatric and adolescent urologic cancer.
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Affiliation(s)
- Armando J Lorenzo
- Department of Surgery, Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
| | - Rodrigo L P Romao
- Division of Urology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada; Division of Pediatric General Surgery, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
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8
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Lopes RI, Ming J, Koyle MA, Grant R, Fonseca A, Lorenzo AJ. "Zero-Ischemia" Laparoscopic-assisted Partial Nephrectomy for the Management of Selected Children With Wilms Tumor Following Neoadjuvant Chemotherapy. Urology 2016; 100:103-110. [PMID: 27720972 DOI: 10.1016/j.urology.2016.08.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/22/2016] [Accepted: 08/25/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the experience and technique of zero-ischemia laparoscopic-assisted partial nephrectomy at The Hospital for Sick Children, as an alternative to the traditional open approach for nephron-sparing surgery (NSS) in selected children with Wilms tumor (WT). MATERIALS AND METHODS Patients with diagnosis of WT treated with neoadjuvant chemotherapy and who underwent laparoscopic-assisted NSS at the Hospital for Sick Children from 2012 to 2016 were identified and their charts were reviewed retrospectively. Patients underwent laparoscopic exploration, lymph node sampling, kidney mobilization, vascular control, and adrenal sparing. This was followed by open NSS through a small flank incision; no clamping of the hilum or major renal branches was performed. RESULTS Six patients were identified; all patients underwent successful resection. One patient required radical nephrectomy due to inability to safely define negative margins. Tumors ranged in size from 0.9 to 5.6 cm in diameter. Mean operating time was 293 ± 50.2 minutes, with an average duration of pneumoperitoneum of 216 ± 27 minutes. Intraoperative blood loss was negligible. No tumor spillages occurred. Postoperative pathology revealed negative margins in all resected specimens. One case of urine leak occurred postoperatively, which resolved spontaneously. Renal function was preserved in all children. At a mean follow up of 11.5 months, all patients have been recurrence free. CONCLUSION The herein presented strategy allows for safe nephron-sparing resection of selected WT with acceptable morbidity, good short-term disease-free survival, and potentially better cosmesis and recovery than traditional open surgery. This preliminary experience suggests that minimally invasive options for NSS in children merit further evaluation.
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Affiliation(s)
- Roberto Iglesias Lopes
- Department of Surgery, Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Ming
- Department of Surgery, Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Martin A Koyle
- Department of Surgery, Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ronald Grant
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Fonseca
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Armando J Lorenzo
- Department of Surgery, Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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9
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Eriksen KO, Johal NS, Mushtaq I. Minimally invasive surgery in management of renal tumours in children. Transl Pediatr 2016; 5:305-314. [PMID: 27867856 PMCID: PMC5107380 DOI: 10.21037/tp.2016.09.04] [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: 12/29/2022] Open
Abstract
Minimally invasive surgery (MIS) in the management of malignant and benign renal tumours in children is gradually becoming more common. Experience is limited and restricted to case reports, retrospective chart reviews and a few cohort studies. There are currently no randomized controlled trials or controlled clinical trials comparing the laparoscopic and open surgical approach for the management of renal tumours in children. MIS may offer the same oncologic outcome in malignant renal tumours whilst providing the advantages associated with MIS in correctly selected cases. The technique for tumour resection has been shown to be feasible in regards to the recommended oncologic principles, although lymph node sampling can be inadequate in some cases. Preliminary reports do not show an increased risk of tumour rupture or inferior oncologic outcomes after MIS. However, the sample size remains small and duration of follow-up inadequate to draw any firm conclusions. Implementation of MIS is lacking in the protocols of the major study groups, and standardized recommendations for the indications and contra-indications remain undefined. The objective of this article is to present a review of the literature on the role of MIS in the management of renal tumours in children, with the main focus on Wilms' tumour (WT). Further studies on MIS in renal tumours are required to evaluate the incidence of oncological complications such as complete tumour resection and intra-operative tumour spillage. A long-term follow-up of patients managed by MIS is essential to compare recurrence rates and overall survival rates.
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Affiliation(s)
| | - Navroop Singh Johal
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Imran Mushtaq
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, UK
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10
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Kieran K, Ehrlich PF. Current surgical standards of care in Wilms tumor. Urol Oncol 2015; 34:13-23. [PMID: 26122713 DOI: 10.1016/j.urolonc.2015.05.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Wilms tumor (WT) is the second most common abdominal tumor in children. METHODS This chapter discusses surgical considerations for the management of unilateral and bilateral WT. RESULTS Currently, survival exceeds 90%, owing to multicenter studies under the auspices of the Children's Oncology Group and Société Internationale d'Oncologie Pédiatrique. Surgical excision remains the mainstay of oncologic control and is also crucial for proper staging of disease in order to direct adjuvant therapy and limit treatment-related morbidity. CONCLUSIONS Careful attention must be paid to proper disease staging, upfront and adjuvant therapy, and surgical technique in order to optimize oncologic outcomes while minimizing short- and long-term morbidity.
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Affiliation(s)
- Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98109.
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11
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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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12
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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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13
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Godzinski J. The current status of treatment of Wilms' tumor as per the SIOP trials. J Indian Assoc Pediatr Surg 2015; 20:16-20. [PMID: 25552825 PMCID: PMC4268749 DOI: 10.4103/0971-9261.145439] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This paper attempts to briefly describe the International Society of Paediatric Oncology (SIOP) policy of treatment of nephroblastoma since first study (SIOP 1) launched in 1971 until today. It focuses on the advantages of the preoperative chemotherapy and the stratification of patients induced this way. Marked efficacy of the pretreatment opened the way for less aggressive surgical management also in case of the "so-called" regular unilateral cases: Nephron-sparing surgery and minimal invasive techniques will probably find its place in this field of pediatric surgical oncology; however, very careful selection of cases must be the priority.
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Affiliation(s)
- Jan Godzinski
- Department of Paediatric Surgery, Marciniak Hospital, Wroclaw, Poland
- Department of Emergency Medicine, Medical University, Wroclaw, Poland
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14
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Warmann SW, Godzinski J, van Tinteren H, Heij H, Powis M, Sandstedt B, Graf N, Fuchs J. Minimally invasive nephrectomy for Wilms tumors in children - data from SIOP 2001. J Pediatr Surg 2014; 49:1544-8. [PMID: 25475791 DOI: 10.1016/j.jpedsurg.2014.06.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 06/04/2014] [Accepted: 06/05/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To analyse the surgical and oncological outcome of minimally invasive surgery (MIS) for tumor nephrectomy in Wilms tumor (WT) patients. METHODS WT patients from the SIOP 2001 trial, undergoing MIS for tumor nephrectomy were analyzed with regard to demographic characterization, surgical specifications, complications, and outcome. RESULTS There were 24 children matching the inclusion criteria. Median age at operation was 40.35 months (14.3-65.4). All patients received preoperative chemotherapy. Median tumor volume was 177.5 ml at diagnosis (46.5-958) and 73.0 ml at surgery (3.8-776). There was one surgical complication (splenic injury), no intraoperative tumor rupture occurred. Abdominal stage was I in 14, II in 7, and III in 3 patients. Adequate lymph node sampling was performed in only 2 patients. One local relapse occurred. Event-free survival was 23/24, overall survival was 24/24, median follow up was 47 months (2-114). CONCLUSIONS We present the largest series so far of minimally invasive nephrectomies for nephroblastoma based on a multinational trial. Treatment results were comparable to those of open surgery; however, experience of operating surgeons was generally high. Discipline of lymph node sampling was inadequate. Based on this analysis a prospective study on MIS in nephroblastoma is planned by the SIOP Renal Tumor Study Group.
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Affiliation(s)
- Steven W Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Germany.
| | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw and Chair of Emergency Medicine, Medical University, Wroclaw, Poland
| | | | - Hugo Heij
- Pediatric Surgical Center of Amsterdam (ECH-AMC/VUmc), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark Powis
- Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Bengt Sandstedt
- Childhood Cancer Research Unit, Astrid Lindgren's Children's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Norbert Graf
- Department of Pediatric Hematology and Oncology, University Hospital Homburg/Saar, Germany
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tuebingen, Germany
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15
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Gleason JM, Lorenzo AJ, Bowlin PR, Koyle MA. Innovations in the management of Wilms' tumor. Ther Adv Urol 2014; 6:165-76. [PMID: 25083165 DOI: 10.1177/1756287214528023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Advances in the management of Wilms' tumor have been dramatic over the past half century, not in small part due to the institution of multimodal therapy and the formation of collaborative study groups. While different opinions exist in the management of Wilms' tumors depending on where one lives and practices, survival rates have surpassed 90% across the board in Western societies. With more children surviving into adulthood, the concerns about morbidity have reached the forefront and now represent as much a consideration as oncologic outcomes these days. Innovations in treatment are on the horizon in the form of potential tumor markers, molecular biological means of testing for chemotherapeutic responsiveness, and advances in the delivery of chemotherapy for recurrent or recalcitrant tumors. Other technological innovations are being applied to childhood renal tumors, such as minimally invasive and nephron-sparing approaches. Risk stratification also allows for children to forego potentially unnecessary treatments and their associated morbidities. Wilms' tumor stands as a great example of the gains that can be made through protocol-driven therapy with strenuous outcomes analyses. These gains continue to spark interest in minimization of morbidity, while avoiding any compromise in oncologic efficacy. While excitement and innovation are important in the advancement of treatment delivery, we must continue to temper this enthusiasm and carefully evaluate options in order to continue to provide the highest standard of care in the management of this now highly curable disease.
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Affiliation(s)
- Joseph M Gleason
- Division of Paediatric Urology, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Paediatric Urology, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Paul R Bowlin
- Division of Paediatric Urology, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Paediatric Urology, The Hospital for Sick Children, Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada M5G 1X8
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16
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Laparoscopic radical nephrectomy for the management of chromophobe renal cell carcinoma in a 13-year-old girl. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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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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18
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Romao RLP, Weber B, Gerstle JT, Grant R, Pippi Salle JL, Bägli DJ, Figueroa VH, Braga LHP, Farhat WA, Koyle MA, Lorenzo AJ. Comparison between laparoscopic and open radical nephrectomy for the treatment of primary renal tumors in children: single-center experience over a 5-year period. J Pediatr Urol 2014; 10:488-94. [PMID: 24331167 DOI: 10.1016/j.jpurol.2013.11.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 11/01/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare the outcomes of laparoscopic nephrectomy (LN) with open radical nephrectomy (ORN) in the management of consecutive pediatric neoplasms. PATIENTS AND METHODS Retrospective cohort study of consecutive children treated for primary renal tumors between 2006 and 2011, segregated based on surgical modality (LN/ORN). Pre-, intra- and postoperative data and outcomes were collected. RESULTS Demographics from the 45 patients (13 LN, 32 ORN) were similar, and tumors in the LN group were smaller [6.59 ± 1.8 cm vs. 10.99 ± 2.99 cm ORN (p < 0.05)]. Six patients had preoperative chemotherapy (two LN, four ORN). No tumor ruptures occurred with either technique. Wilms tumor (seven LN, 24 ORN) was the most common diagnosis, followed by renal cell carcinoma (four LN, four ORN). Procedure length was similar between groups (282 ± 79 LN, 263 ± 81 min ORN). Mean length of stay was significantly shorter for LN (2.9 vs. 5.9 days; p = 0.002). Postoperative narcotic requirements and use of nasogastric tube were higher in the ORN group. After a median follow-up of 18 (LN) and 33 months (ORN), 1 and 4 recurrences occurred, respectively. CONCLUSIONS LN is an attractive alternative to open surgery in carefully selected cases of pediatric renal tumors. Procedure length and incidence of intra-operative rupture were not increased, while post-operative recovery and hospital stay were shorter for LN. Longer follow-up is mandatory to confirm comparable oncological outcomes to ORN.
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Affiliation(s)
- R L P Romao
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Divisions of Urology and General Surgery, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - B Weber
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Division of Urology, Alberta Children's Hospital, University of Alberta, Calgary, AB, Canada
| | - J T Gerstle
- Division of General and Thoracic Surgery, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - R Grant
- Department of Pediatrics, Division of Oncology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - J L Pippi Salle
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - D J Bägli
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - V H Figueroa
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - L H P Braga
- Division of Urology, McMaster Children's Hospital and McMaster University, Hamilton, ON, Canada
| | - W A Farhat
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - M A Koyle
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - A J Lorenzo
- Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
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19
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Varlet F, Petit T, Leclair MD, Lardy H, Geiss S, Becmeur F, Ravasse P, Rod J, de Lambert G, Braik K, Lardellier-Reynaud F, Lopez M. Laparoscopic treatment of renal cancer in children: a multicentric study and review of oncologic and surgical complications. J Pediatr Urol 2014; 10:500-5. [PMID: 24332932 DOI: 10.1016/j.jpurol.2013.11.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 11/04/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim was to report a multicentric study with a longer follow-up to evaluate the laparoscopic radical nephrectomy in children with renal cancer. MATERIAL AND METHODS This was a retrospective multicentric study, from October 2005 to January 2012, of children who underwent a laparoscopic radical nephrectomy for small renal malignant tumors. RESULTS Seventeen children were included in this study. Sixteen underwent chemotherapy before surgery according the SIOP (Société Internationale d'Oncologie Pédiatrique) protocol and one was treated by surgery only for a carcinoma. All except one could be treated by laparoscopy; the biggest tumoral size was 8 cm. The median hospital stay was 3 days (2-10). The pathologic examination showed 15 Wilms' tumors, one clear cell sarcoma and one TFE3 renal cell carcinoma. With a median follow-up of 42 months (range 12 and 77 months) after laparoscopic radical nephrectomy, 15 children had no oncological complications (port site or local recurrence, pulmonary metastasis) and one had a local recurrence without intraoperative tumoral rupture. The child with TFE3 renal cell carcinoma died 4 years after surgery from brain and lung metastases without local recurrence. No small bowel obstruction occurred. CONCLUSIONS Radical nephrectomy in children for Wilms' tumor or other renal cancer can be safely performed laparoscopically and our indications can be summarized, for trained laparoscopic surgeons, by small tumors under about 8 cm diameter, especially without crossing the lateral edge of the vertebra on the CT scan at the time of surgery.
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Affiliation(s)
- François Varlet
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Nord, Saint-Etienne, France.
| | - Thierry Petit
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Caen, France
| | - Marc-David Leclair
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Mere enfant, Nantes, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Clocheville, Tours Cedex, France
| | - Stephan Geiss
- Department of Pediatric Surgery, Centre Hospitalier, Centre de la mere et de l'enfant Le Parc, Colmar, France
| | - François Becmeur
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Hautepierre, Strasbourg, France
| | - Philippe Ravasse
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Caen, France
| | - Julien Rod
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Caen, France
| | - Guénolée de Lambert
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Clocheville, Tours Cedex, France
| | - Karim Braik
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Clocheville, Tours Cedex, France
| | | | - Manuel Lopez
- Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Nord, Saint-Etienne, France
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20
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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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21
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Current status of minimal access surgery in children. APOLLO MEDICINE 2013. [DOI: 10.1016/j.apme.2013.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Piché N, Barrieras D. Minimally invasive nephron-sparing surgery for unilateral Wilms tumor. J Pediatr Surg 2012; 47:E1-4. [PMID: 22813823 DOI: 10.1016/j.jpedsurg.2012.02.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/22/2012] [Accepted: 02/08/2012] [Indexed: 11/29/2022]
Abstract
Minimally invasive surgery (MIS) for nephrectomy has been described since the early 1990s. More recently, MIS has been used for nephron-sparing surgery (NSS) when treating benign conditions. However, reports of NSS using MIS for malignant conditions are sparse. In this report, we describe our retroperitoneal laparoscopic approach for NSS for a localized Wilms tumor.
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Affiliation(s)
- Nelson Piché
- Division of Pediatric General Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
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23
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Abstract
The management of Wilms' tumor emerging of the outstanding clinical trials undertaken in the developed world in the last four decades has led to excellent longterm outcomes. The scenario in developing country like India is different; late presentation with massive tumors and advanced stage, lacunae in staging, nonavailability of pediatric medical oncologists and poor follow-ups are common. A comprehensive summary of available therapeutic modalities is provided here along with clear roadmaps of management of Wilms' tumor as per Société Internationale d'Oncologie Pédiatrique (SIOP) and National Wilms' Tumor Study Group/Children's Oncology Group (NWTSG/COG) protocols in simple tabulated form.
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24
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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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25
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Abstract
Significant improvement has been made in the treatment of children with Wilms tumor. New protocols are in place designed to maintain a high rate of cure for these patients while minimizing toxicity, based on refinement of the risk-stratification system.
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Affiliation(s)
- Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
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26
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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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27
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Rauth TP, Slone J, Crane G, Correa H, Friedman DL, Lovvorn HN. Laparoscopic nephron-sparing resection of synchronous Wilms tumors in a case of hyperplastic perilobar nephroblastomatosis. J Pediatr Surg 2011; 46:983-8. [PMID: 21616266 PMCID: PMC3105348 DOI: 10.1016/j.jpedsurg.2011.01.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 01/25/2011] [Accepted: 01/26/2011] [Indexed: 11/25/2022]
Abstract
Diffuse hyperplastic perilobar nephroblastomatosis (DHPLN) is a rare precursor lesion of Wilms tumor (WT). Because of the increased risk to develop WT in either kidney, current management algorithms of DHPLN merit nephron-sparing strategies, beginning with chemotherapy and close radiographic monitoring into late childhood. After resolution of DHPLN, subsequent detection of a renal nodule mandates resection to exclude WT. Here, we report the case of a 4-year-old girl who developed 2 synchronous nodules in the right kidney more than 2 years after completion of therapy for DHPLN. Because of the early detection and peripheral location of these 2 nodules, laparoscopic nephron-sparing resection of each was performed using ultrasonic dissection. Both nodules were determined on pathology to be favorable histology WT with negative surgical margins. The child was placed on vincristine and actinomycin D therapy for 18 weeks.
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Affiliation(s)
| | - Jeremy Slone
- Department of Pediatric Surgery, Division of Pediatric Hematology-Oncology, Vanderbilt University School of Medicine, Monroe Carrel, Jr. Children’s Hospital, Nashville, TN
| | - Gabriella Crane
- Division of Pediatric Radiology, Vanderbilt University School of Medicine, Monroe Carrel, Jr. Children’s Hospital, Nashville, TN
| | - Hernan Correa
- Division of Pediatric Pathology, Vanderbilt University School of Medicine, Monroe Carrel, Jr. Children’s Hospital, Nashville, TN
| | - Debra L. Friedman
- Department of Pediatric Surgery, Division of Pediatric Hematology-Oncology, Vanderbilt University School of Medicine, Monroe Carrel, Jr. Children’s Hospital, Nashville, TN
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28
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Chui CH, Lee ACW. Peritoneal metastases after laparoscopic nephron-sparing surgery for localized Wilms tumor. J Pediatr Surg 2011; 46:e19-21. [PMID: 21376182 DOI: 10.1016/j.jpedsurg.2010.11.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 11/03/2010] [Accepted: 11/04/2010] [Indexed: 02/05/2023]
Abstract
A 2-year-old girl was referred for the management of the progression of her localized Wilms tumor. She had undergone laparoscopic nephron-sparing surgery for her right Wilms tumor 3 months earlier. Postoperative chemotherapy was commenced 6 weeks later. Subsequent computer tomographic evaluation 12 weeks postsurgery showed local recurrence and peritoneal tumors. These findings were confirmed at laparotomy. We report the first case of peritoneal tumor dissemination after laparoscopic nephron-sparing surgery for localized Wilms tumor.
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Affiliation(s)
- Chan-Hon Chui
- Surgery Centre for Children Pte Ltd, Mount Elizabeth Medical Centre, Singapore.
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29
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Chalmers D, Marietti S, Kim C. Xanthogranulomatous Pyelonephritis in an Adolescent. Urology 2010; 76:1472-4. [DOI: 10.1016/j.urology.2010.03.076] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 03/31/2010] [Accepted: 03/31/2010] [Indexed: 11/30/2022]
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30
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Abstract
Wilms' tumor is the most common malignant renal tumor in children. Survival has improved dramatically over time as a result of prospective randomized clinical trials conducted by the pediatric cooperative cancer groups. Current research is directed toward identifying low-risk patients for whom a reduction in treatment intensity would decrease long-term morbidity. This article reviews the most recent advances in the biology and treatment of children with Wilms' tumor.
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Affiliation(s)
- Leah Nakamura
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
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31
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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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