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Minimally Invasive Surgery in Pediatric Surgical Oncology: Practice Evolution at a Contemporary Single-Center
Abdelhafeez Abdelhafeez1, Lucia Ortega-Laureano1, Andrew J Murphy1
11Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.
Abstract:
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. We retrospectively reviewed the medical records of patients with pediatric cancer treated with MIS at a single institution between 2000 and 2014. 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). 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.
Insights
Minimally invasive surgery (MIS) is increasingly used in pediatric surgical oncology for diagnosis and tumor resection. This study shows MIS is safe and effective, with low complication rates and no tumor upstaging, supporting further research.
Area of Science:
- Pediatric Surgical Oncology
- Minimally Invasive Surgery (MIS)
Background:
- Minimally invasive surgery (MIS) adoption in pediatric surgical oncology is growing despite limited evidence from controlled trials.
- Evaluating the implementation and evolution of MIS in a pediatric tertiary cancer center is crucial.
Purpose of the Study:
- To assess the current use of MIS in pediatric cancer treatment.
- To compare contemporary MIS utilization with previous data from the same institution.
Main Methods:
- Retrospective review of medical records for pediatric cancer patients treated with MIS between 2000 and 2014.
- Analysis of 252 MIS procedures, including laparoscopic and thoracoscopic approaches, for diagnostic and therapeutic purposes.
Main Results:
- MIS was performed in 252 cases (73 laparoscopic, 179 thoracoscopic), predominantly for diagnosis (59%) and tumor resection (24%).
- Conversion to open surgery occurred in 6-7% of cases due to technical challenges.
- Complication rates were low (2% for resections, 3% for diagnostics), with no instances of tumor upstaging or recurrence.
Conclusions:
- Minimally invasive surgery has evolved as a viable option for managing solid tumors in children.
- Establishment of prospective trials is encouraged to further evaluate MIS in pediatric surgical oncology.
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