Abdominal tumors in children

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.

Minimally invasive surgery for unilateral Wilms tumors: Multicenter retrospective analysis of 50 transperitoneal laparoscopic total nephrectomies

“…In total, we report that the technique is feasible in 19% of tumors. This is comparable to previous reports of MIS for abdominal tumors in children 17,18 . We consider that it is still valuable in reducing long‐term morbidity, such as adhesion‐related complications 2 and presence of visible scars that alter quality of life 3 for almost 20% of patients.…”

“…This is comparable to previous reports of MIS for abdominal tumors in children. 17,18 We consider that it is still valuable in reducing long-term morbidity, such as adhesion-related complications 2 and presence of visible scars that alter quality of life 3 for almost 20% of patients. Additionally, as shown in the series, the larger the tumor, the higher the risk of conversion.…”

Accuracy of MRI in the Differential Diagnosis of Wilms Tumor

“…In a similar study involving Iranian children with adnominal mass, Zareifar et al (22) (2016) reported comparable mean age of 4.8±4.2 years with similar higher proportion of males (1.9:1) and under 5 years age group (62.4%). A comparable mean age of 6.1±5.2 years has been reported by Oh et al (23) (2016) in Chinese children with abdominal mass while Solomon et al (24) (2017) observed similar higher proportion of under 5 years children in Ethiopia.…”

Pediatric minimally invasive surgery for malignant abdominal tumor

“…The range of MIS applications is now widening, from benign diseases to tumors, and studies on its use for malignant diseases are also being published. In 2016, Oh et al [21] reported that MIS is safe for the diagnosis and treatment of intraperitoneal tumors, including benign and malignant diseases. In particular, adrenalectomy and nephrectomy have been actively researched, [11,12,22,23,24,25,26] but there is no confirmed indication for MIS.…”