Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors-A Nationwide Experience

被引:28
|
作者
Blanc, Thomas [1 ,2 ,3 ]
Meignan, Pierre [1 ,4 ]
Vinit, Nicolas [1 ]
Ballouhey, Quentin [5 ]
Pio, Lucas [1 ]
Capito, Carmen [1 ]
Harte, Caroline [6 ]
Vatta, Fabrizio [1 ]
Galmiche-Rolland, Louise [7 ]
Minard, Veronique [8 ]
Orbach, Daniel [9 ]
Berteloot, Laureline [10 ]
Muller, Cecile [1 ]
Kohaut, Jules [1 ]
Broch, Aline [1 ]
Braik, Karim [4 ]
Binet, Aurelien [4 ]
Heloury, Yves [1 ,2 ]
Fourcade, Laurent [5 ]
Lardy, Hubert [4 ]
Sarnacki, Sabine [1 ,2 ]
机构
[1] Hop Necker Enfants Malad, AP HP, Dept Pediat Surg & Urol, Paris, France
[2] Univ Paris, Paris, France
[3] Univ Paris, Dept Croissance & Signalisat, Ctr Natl Rech Sci UMR8253, Inst Natl Sante & Rech Med U1151,Inst Necker Enfa, Paris, France
[4] Hop Clocheville, Dept Pediat Surg, Tours, France
[5] Hop Enfants, Dept Pediat Surg, Limoges, France
[6] Hop Necker Enfants Malad, AP HP, Dept Pediat Anesthesia, Paris, France
[7] Hop Necker Enfants Malad, AP HP, Dept Pathol, Paris, France
[8] Inst Gustave Roussy, Dept Pediat & Adolescent Oncol, Villejuif, France
[9] PSL Res Univ, Dept Pediat Oncol, SIREDO Oncol Ctr Care Innovat & Res Children & AY, Inst Curie, Paris, France
[10] Hop Necker Enfants Malad, AP HP, Dept Pediat Radiol, Paris, France
关键词
MINIMALLY INVASIVE SURGERY; LAPAROSCOPIC SURGERY; WILMS-TUMOR; CANCER; CHILDHOOD;
D O I
10.1245/s10434-021-10777-6
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background While robotics has become commonplace in adult oncology, it remains rare in pediatric oncology due to the rarity of childhood cancers. We present the results of a large nationwide experience with robotic oncology, with the aim of providing practical and feasible guidelines for child selection. Methods This was a prospective analysis performed over a period of 4 years. Treatment was delivered according to the Societe Internationale d'Oncologie Pediatrique/International Society of Paediatric Oncology Europe Neuroblastoma Group (SIOP/SIOPEN) protocols. Indications were approved by a certified tumor board. Results Overall, 100 tumors were resected during 93 procedures (abdomen, 67%; thorax, 17%; pelvis, 10%; retroperitoneum, 6%) in 89 children (56 girls). The median age at surgery was 8.2 years (range 3.6-13); 19 children (21%) harbored germinal genetic alterations predisposing to cancer. No intraoperative tumor ruptures occurred. Seven conversions (8%) to an open approach were performed. Neuroblastic tumors (n = 31) comprised the main group (18 neuroblastomas, 4 ganglioneuroblastomas, 9 ganglioneuromas) and renal tumors comprised the second largest group (n = 24, including 20 Wilms' tumors). The remaining 45 tumors included neuroendocrine (n = 12), adrenal (n = 9), germ-cell (n = 7), pancreatic (n = 4), thymic (n = 4), inflammatory myofibroblastic (n = 4), and different rare tumors (n = 5). Overall, 51 tumors were malignant, 2 were borderline, and 47 were benign. The median hospital stay was 3 days (2-4), and five postoperative complications occurred within the first 30 days. During a median follow-up of 2.4 years, one child (Wilms' tumor) presented with pleural recurrence. One girl with Wilms' tumor died of central nervous system metastasis. Conclusions Robotic surgery for pediatric tumors is a safe option in highly selected cases. Indications should be discussed by tumor boards to avoid widespread and uncontrolled application.
引用
收藏
页码:1315 / 1326
页数:12
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