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Laparoscopic Excision of Large Wilms Tumor in Children: A Single-Center Experience from a Resource-Challenged Nation
1Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Insights
Minimally invasive surgery (MIS) is feasible and safe for removing large Wilms tumors (WT) in children. Simple maneuvers and an extended lumbotomy incision facilitate successful laparoscopic tumor resection and lymph node sampling.
Area of Science:
- Pediatric Surgery
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Wilms tumor (WT) is a common pediatric kidney cancer.
- Surgical approach selection is crucial for optimal outcomes in pediatric oncology.
- Minimally invasive surgery (MIS) offers potential benefits but its application in large WT requires evaluation.
Purpose of the Study:
- To review outcomes of children with Wilms tumor (WT) treated with minimally invasive surgery (MIS).
- To highlight essential surgical steps for laparoscopic excision of large WTs.
- To assess the feasibility and safety of MIS for large WT in pediatric patients.
Main Methods:
- Retrospective study of children with unilateral WT undergoing resection over 4 years (July 2013-July 2017).
- Utilized simple maneuvers (table tilting, blunt cannula) for dissecting large WT and an extended lumbotomy for tumor retrieval and lymph node sampling.
- Eleven patients with Stage III WT underwent laparoscopic tumor resection.
Main Results:
- Median age at presentation was 36 months, median tumor volume 1140 cm³.
- Median hospital stay was 6 days; two complications (port-site recurrence, SSI) occurred.
- All patients achieved long-term survival after a median follow-up of 86 months.
Conclusions:
- Minimally invasive surgery (MIS) is a feasible and safe approach for resecting large Wilms tumors (WT) in children.
- Simple surgical maneuvers can overcome challenges associated with large tumor size during laparoscopic procedures.
- An extended lumbotomy incision allows for adequate lymph node sampling during MIS for WT.
Abstract:
In this study, we aim to review the outcomes of children with Wilms tumor (WT) operated through the minimally invasive surgery (MIS) approach at our center. We also intend to highlight essential surgical steps during laparoscopic excision of large WTs. This retrospective study included children with unilateral WT who had undergone resection for a period of 4 years, w.e.f. July 2013 to July 2017. Simple maneuvers such as tilting the table in different positions and use of blunt metallic cannula to lift the tumor to access the hilar vessels were used to dissect large WT. An extended lumbotomy incision was used for retrieval of tumor and lymph-node sampling. Eleven patients (male:female = 7:4) of WT, all having stage III disease, had undergone laparoscopic tumor resection at our center during the study period. The median age at presentation was 36 months (range = 17 months-5 years) and the median preoperative tumor volume was 1140 (range = 936-1560) cm3. The average length of the lumbotomy incision was 6.3 (range = 5-8.2) cm. The median hospital stay was 6 (range = 5-10) days. Two children developed complications (port-site recurrence and grade III surgical site infection in one each) during the postoperative period. All cases are long-term survivors after a median follow-up of 86 (range = 56-104) months. This study highlights the feasibility and safety of the removal of large WT through the MIS approach. Problems due to large-sized tumors in children can be overcome by simple maneuvers. Also, adequate lymph node sampling is possible with a suitably placed extended lumbotomy incision for tumor removal.
