Management of abdominal lymphoproliferative diseases in the era of laparoscopy

Silecchia, Gianfranço; Fantini, A; Raparelli, Luigi; Leo, A. De; Vitolo, Domenico; Monarca, Bruno; Bezzi, Mario; Rosato, P.; Basso, Nicola

doi:10.1016/s0002-9610(99)00056-2

Cited by 22 publications

(15 citation statements)

References 15 publications

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“…3,4,23 The spectrum of malignancies included the whole range of pediatric abdominal, retroperitoneal, and thoracic tumors, such as neuroblastoma, nephroblastoma, hepatoblastoma, rhabdomyosarcoma, teratoma, lymphoma, and numerous others. 3,4,8,13,[23][24][25][26] The conversion rate was less than 5%, the diagnostic accuracy of biopsies was up to 100%, and there were no major intra-or postoperative complications. 13,23,24,26 Our data confirmed an excellent feasibility of minimally invasive biopsy with an accuracy of 98% and a conversion rate of 15% in laparoscopic and 7% in thoracoscopic biopsies.…”

Section: Discussionmentioning

confidence: 99%

Role of diagnostic and ablative minimally invasive surgery for pediatric malignancies

Metzelder

Kuebler

Shimotakahara

et al. 2007

Cancer

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BACKGROUNDThe use of minimally invasive surgery (MIS) in pediatric cancer is a matter of debate. The diagnostic and ablative roles of MIS were evaluated in a consecutive series of children with malignancies.METHODSA prospective study, including all patients, who underwent abdominal and thoracic surgery for confirmed or highly suspected pediatric cancer was performed from September, 2000, to December, 2005. An interdisciplinary panel approved the indication for minimally invasive or conventional surgery.RESULTSAt a single institution, 301 operations were performed on 276 children with cancer. A minimally invasive approach was attempted in 90 of these patients (30%) and successfully employed in 69 (77%) of the operations. However, 21 operations (23%) were converted to an open approach. Regarding the abdominal operations attempted laparoscopically, 41 abdominal operations for biopsy or staging purposes were attempted laparoscopically (53%), but 6 were converted. In all, 139 abdominal resections were performed and 24 were attempted laparoscopically. Ten of these (42%) were converted. In 34 thoracic operations requiring biopsy, thoracoscopy was attempted in 14 (41%) and was successful in all but 1 (93%). Fifty‐one thoracic tumors were resected and the thoracoscopic approach was attempted in 11 (22%) and successful in 7 (14%). Conversions from a minimally invasive operation to an open procedure occurred mainly due to limited visibility. Three bleeding complications occurred with 1 patient requiring a blood transfusion. In addition, 1 small bowel injury occurred with immediate laparoscopic closure. There were no port site recurrences after a median of 39 months.CONCLUSIONSMIS is a reliable diagnostic tool for pediatric abdominal and thoracic malignancy. The role of ablative MIS in pediatric cancer remains limited. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Role of diagnostic and ablative minimally invasive surgery for pediatric malignancies

Metzelder

Kuebler

Shimotakahara

et al. 2007

Cancer

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“…It is difficult to decide whether splenectomy is an appropriate choice and to determine the proper time to operate. Previous studies using diagnostic laparoscopy for an etiologic diagnosis of FUO showed a diagnostic accuracy ranging from 44 to 100% [1, 2]. Few publications have focused on splenectomy in FUO with hepatomegaly and splenomegaly, and even fewer on the risk factors of splenectomy at this stage.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Splenectomy in Patients with Fever of Unknown Origin and Splenomegaly

Han

Yang²,

Yang

et al. 2008

Acta Haematol

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Objective: To review the diagnostic significance, safety and possible risk factors of splenectomy in fever of unknown origin (FUO) with splenomegaly. Methods: The records of 54 patients with FUO and splenomegaly who underwent splenectomy in our hospital in the past 20 years were reviewed retrospectively. Pathologic findings, morbidity, mortality and possible risk factors were analyzed. Results: Histologic findings included 29 cases of non-Hodgkin lymphoma, 4 cases of spleen tuberculosis, 3 cases of Hodgkin lymphoma, 1 case of Castleman disease and 2 cases of hemophagocytic syndrome. An etiologic diagnosis was made in 72.2% of the patients undergoing splenectomy. Surgical complications occurred in 25.9% of the patients and 1-month operative mortality was 16.7%. The mortality rate 1 month after surgery was significantly associated with serous cavity effusion (46.2 vs. 7.5%, p = 0.006) and spleen weight >1,500 g (50.0 vs. 9.1%, p = 0.007). There was no significant difference in the mortality rate of the patients with or without jaundice, pancytopenia, elevated serum alanine aminotransferase (ALT) or elevated LDH (p > 0.5). Multivariate analysis revealed serous cavity effusion (odds ratio 21.0; 95% confidence interval 2.2–212.8; p = 0.01) and spleen weight >1,500 g (odds ratio 18.0; 95% confidence interval 1.9–173.8; p = 0.01) as independent risk factors. Conclusion: Splenectomy is an effective diagnostic modality for FUO presenting with splenomegaly. The presence of serous cavity effusions and spleen weight >1,500 g identifies patients with the greatest operative risk.

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“…A retrospective analysis of 70 patients published by Kortsik et al [11] found that in patients with FUO, the cause of fever was directly or indirectly diagnosed by laparoscopy in 44% of the cases. In more recent study, Silecchia et al [18] reported successful diagnosis by laparoscopy in 28 patients who presented initially with FUO. Lymphoma was found in 19 cases, lymphadenitis in five cases, amyloidosis in one case, tuberculosis in one case, HIV splenitis in one case, and chronic hepatitis in one case.…”

Section: Discussionmentioning

confidence: 99%

“…A previous study from our institution on 25 patients managed between 1976 and 1988 who underwent a protocolized laparotomy showed a diagnostic accuracy of 64%, with an operative morbidity of 12% and a mortality of 4% [19]. Although exploratory laparotomy is rarely necessary, at the time of laparotomy, most patients with FUO are in bad general condition, resulting in high operative risk for wound complications such as infection, seroma, and healing failure [4,8,9,11,12,17,18]. Several studies using diagnostic laparoscopy for the management of lymphoproliferative diseases have been published [1,11,15,17,18,20], but few have focused on FUO.…”

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confidence: 99%