Maintaining oncologic integrity with minimally invasive resection of pediatric embryonal tumors

Phelps, Hannah M.; Ayers, Gregory D.; Ndolo, Josephine M.; Dietrich, Hannah L.; Watson, Katherine D.; Hilmes, Melissa A.; Lovvorn, Harold N.

doi:10.1016/j.surg.2018.03.020

Cited by 16 publications

(21 citation statements)

References 23 publications

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“…Systematic reviews of larger pediatric studies have been recently presented by Abdelhafeez et al Outcome. The summary of 8 studies performed between 2007-2018 aimed at evaluating MIS in tumor resection, including 213 patients, showed gross total resection in 94.3%, with negative margins in 77.0% and a 10.8% (23/213) conversion rate to open surgery, leading to a median overall survival of 100% (range=84-100%) and median event-free survival 95% (range=77-100%) at median followup of 28 months (range=16-58 months) (14,15,(18)(19)(20)(21)(22)(23)(24). The conversion rate itself, reported in 14 large studies including >50 patients each, was 15.5% (214/1379) (3,4,14,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34).…”

Section: Pediatric Oncology: Summary Of Reported Datamentioning

confidence: 99%

Minimally Invasive Surgery in Pediatric Oncology: Proposal of Guidelines

et al. 2019

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Background/Aim: The objective of the study was to propose clinical guidelines for the use of minimally invasive surgery (MIS) in pediatric oncology. Patients and Methods: Two groups of experts, including pediatric surgeons and pediatric oncologists were created in order to establish strategies of diagnostic and therapeutic surgical management in pediatric oncology. Results: On the basis of the analysis of the existing literature, we elaborated guidelines that were graded according to the simple practical clinical system: yes/no. This project was dedicated to the following topics: adrenal tumors including neuroblastoma, renal tumors including Wilms tumor (nephroblastoma), ovarian tumors and pulmonary nodules and metastases (osteosarcoma). Conclusion: Although existing data do not allow the recommendation of the use of MIS for all indications, this technique should currently be regarded as a standard of care in several areas of pediatric oncology. Minimally invasive surgery (MIS), in contrast to open surgery, is a technique that limits the size of incisions that allow access to peritoneal or thoracic cavities, followed by the use of laparoscope or thoracoscope for visualization and precise dissection. The same target operation should be performed via an open technique or a minimally invasive approach (1-3). The concept of MIS in children with cancer was used for the first time by Holocomb et al. (4), who showed laparoscopy and thoracoscopy to be highly accurate with minimal morbidity for the patient. Both modalities were useful for biopsies, assessment of resectability, staging, evaluation of metastatic or recurrent disease, assessing the potential benefit of second-look procedures, and for diagnosis of infectious complications. The development of this technology has been possible with improved visualization of anatomical structures (5). Subsequent studies and analyses confirmed that MIS procedures in pediatric oncology are safe and effective, resulting in earlier administration of adjuvant therapy. MIS is a developing concept, however in contrast to many areas in adults (6-8), there are no clear guidelines or recommendations in pediatric oncology, mainly due to heterogeneity of clinical diagnoses and small numbers of patients included in the studies. Thus, the aim of this study was to propose clinical guidelines for the use of MIS in pediatric oncology. Guideline Development Overview Two initial groups of experts, including pediatric surgeons and pediatric oncologists were created in order to establish strategies of diagnostic and therapeutic surgical management in pediatric oncology. According to our own experience the relevant issues of MIS utilization in pediatric oncology were defined as follow: adrenal tumors including neuroblastoma (NBL), renal tumors including Wilms tumor (WT), ovarian tumors, pulmonary nodules and metastases. The main desired outcome was evidence of a reduction in open surgery, and secondary outcomes included efficacy and safety, expressed as rate of complications. We performed Pub Med sea...

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Section: Pediatric Oncology: Summary Of Reported Datamentioning

confidence: 99%

Minimally Invasive Surgery in Pediatric Oncology: Proposal of Guidelines

et al. 2019

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“…Of the 99 successful MIS procedures, 53 diagnosed or evaluated disease, 32 managed complications of therapy, 7 removed metastatic deposits, and 7 resected primary tumors (2 splenectomies, 2 oophorectomies, 2 adrenalectomies, and 1 partial hepatectomy) [7]. Over the past 15 years, MIS has increasingly been applied for definitive resection of solid tumors in children, particularly for neuroblastoma (Figure 1) [8,9,10,11,12,13,14]. Recent reports have also described the utility of MIS to resect Wilms tumor either through a nephron-sparing approach or complete nephroureterectomy [8,15,16].…”

Section: History Of Mis For Treating Pediatric Malignancymentioning

confidence: 99%

“…Even fewer have commented on appropriate patient selection for a MIS. Due to the lack of clear evidence regarding patient selection, potential benefits, and the oncologic integrity of a minimally invasive resection, we recently conducted an in-depth analysis of our institutional experience using MIS to resect embryonal tumors [14]. We hypothesized that, among appropriately selected patients, MIS can maintain oncologic integrity while minimizing interruptions to therapy.…”

Section: Efficacy Of Mis To Treat Pediatric Malignancymentioning

confidence: 99%

“…Our recent analysis is the first report that provides an in-depth critique of MIS to achieve gross total resection (GTR, >98% resection of a neuroblastic lesion assessed by postoperative imaging), negative microscopic margins, and adequate lymph node sampling as well as its impact on relapse-free (RFS) and overall survival (OS) [14]. The largest tumor resected with MIS in this cohort measured 100 mL.…”

Section: Efficacy Of Mis To Treat Pediatric Malignancymentioning

confidence: 99%

“…Also, no significant difference in margin status was observed between tumors resected open or with MIS ( p = 0.333). Finally, the median number of lymph nodes sampled with MIS was 1 (interquartile range (IQR) 0, 3) compared to 2 (IQR 1, 5.5) lymph nodes harvested with an open approach ( p = 0.070) [14]. Though not statistically significant, this potential difference indicates that care must be taken to ensure adequate lymph node sampling with a minimally invasive approach.…”

Section: Efficacy Of Mis To Treat Pediatric Malignancymentioning

confidence: 99%

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Minimally Invasive Surgery in Pediatric Surgical Oncology

Phelps

Lovvorn

2018

Children

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The application of minimally invasive surgery (MIS) to resect pediatric solid tumors offers the potential for reduced postoperative morbidity with smaller wounds, less pain, fewer surgical site infections, decreased blood loss, shorter hospital stays, and less disruption to treatment regimens. However, significant controversy surrounds the question of whether a high-fidelity oncologic resection of childhood cancers can be achieved through MIS. This review outlines the diverse applications of MIS to treat pediatric malignancies, up to and including definitive resection. This work further summarizes the current evidence supporting the efficacy of MIS to accomplish a definitive, oncologic resection as well as appropriate patient selection criteria for the minimally invasive approach.

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