Related Experiment Videos
The application of minimal access procedures in infants, children, and young adults with pediatric malignancies
N C Saenz1, K C Conlon, D C Aronson
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Insights
Minimal access procedures, including laparoscopy and thoracoscopy, are safe and effective for pediatric and young adult cancer patients. These minimally invasive surgeries facilitate earlier adjuvant therapy initiation.
Area of Science:
- Oncology
- Minimally Invasive Surgery
- Pediatric Surgery
Background:
- Pediatric and young adult oncology patients often require surgical interventions for diagnosis and staging.
- Traditional open procedures can involve significant morbidity.
Purpose of the Study:
- To analyze the safety and efficacy of minimal access procedures in pediatric and young adult oncology patients.
- To evaluate outcomes of laparoscopic and thoracoscopic procedures in this cohort.
Main Methods:
- Retrospective analysis of 84 patients undergoing 93 minimal access procedures (laparoscopic and thoracoscopic) between 1990 and 1997.
- Review of clinical, pathological, and operative details.
- Data collection on procedure types, conversions to open surgery, complications, and hospital stay.
Main Results:
- A total of 47 thoracoscopic and 46 laparoscopic procedures were performed. Laparoscopic procedures included biopsies and cholecystectomies; thoracoscopic procedures included lung biopsies and pleural procedures.
- Conversion rates to open surgery were 13% for laparoscopy and 23% for thoracoscopy.
- Complication rates were 4% for laparoscopy and 13% for thoracoscopy, with three disease-related deaths in each group. Adequate tissue was obtained in all biopsy procedures.
Conclusions:
- Minimal access procedures are safe and effective for diagnosis and staging in pediatric and young adult cancer patients.
- These techniques enable earlier initiation of adjuvant therapy, potentially improving patient outcomes.
Objective:
In this study, we sought analysis of minimal access procedures in pediatric and young adult oncology patients.
Methods:
Between 1990 and 1997, 84 patients underwent 93 minimal access procedures. Clinical, pathological, and operative details were analyzed.
Results:
There were 32 females and 52 males with a median age of 14 years (range 3 months to 31 years). The median body weight was 50 kg (range 6-94 kg). There were 47 thoracoscopic procedures and 46 laparoscopic procedures. Laparoscopic procedures included liver biopsy (21), diagnostic tumor biopsy (13), lymph node biopsy (4), cholecystectomy (4), oophoropexy (3), and kidney biopsy (1). Median hospital stay was 2 days (range 1-14 days). Six patients had their procedure converted to an open procedure (13%). Thoracoscopic procedures included diagnostic lung biopsy (22), mediastinal mass biopsy or resection (4), pleural biopsy (5), and pleurodesis (4). Eleven were converted to open thoracotomy (23%). Median hospital stay was 4 days (range 2-35 days). There were two complications after laparoscopy (4%) and three disease-related deaths. There were six complications after thoracoscopy (13%), and three disease-related deaths. Adequate tissue was obtained in all biopsy procedures.
Conclusions:
Children with cancer require operations for diagnosis and staging. Minimal access procedures are safe and effective and allow adjuvant therapy to begin earlier.