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Abdominal tumors in children: Comparison between minimally invasive surgery and traditional open surgery
Chaeyoun Oh1, Joong Kee Youn, Ji-Won Han
1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
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.
Insights
Minimally invasive surgery (MIS) is safe and effective for diagnosing and treating pediatric abdominal tumors. MIS showed lower recurrence rates, fewer transfusions, and shorter hospital stays compared to open surgery.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Minimally Invasive Techniques
Background:
- Minimally invasive surgery (MIS) adoption in pediatric abdominal tumor cases is limited, particularly when malignancy is uncertain.
- Existing data on MIS for pediatric abdominal tumors is scarce, necessitating further investigation.
Purpose of the Study:
- To evaluate the safety and feasibility of MIS for diagnosing and treating pediatric abdominal tumors.
- To compare surgical outcomes of MIS versus open surgery in pediatric patients with abdominal tumors.
Main Methods:
- Retrospective review of 205 pediatric patients who underwent diagnostic exploration or curative resection for abdominal tumors between January 2010 and August 2015.
- Comparison of patient characteristics, surgical outcomes, recurrence rates, transfusion requirements, and complication rates between MIS and open surgery groups.
Main Results:
- MIS was utilized in 34.4% of diagnostic explorations and 21.9% of curative resections.
- For curative resections, MIS was associated with significantly lower recurrence rates (6.7% vs. 35.1%), reduced intraoperative transfusions, and shorter hospital stays (4.66 vs. 7.21 days) compared to open surgery.
- Complication rates were similar between MIS and open surgery groups, with conversion rates of 27.2% for diagnostic MIS and 13.1% for curative MIS.
Conclusions:
- Minimally invasive surgery is a feasible and effective approach for the diagnosis and treatment of pediatric abdominal tumors.
- Further multicenter prospective studies with long-term follow-up are required to establish definitive surgical roles and guidelines for MIS in specific pediatric abdominal tumor cases.
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