Abdominal tumors in children Comparison between minimally invasive surgery and traditional open surgery

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 22mL/ 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 followup is warranted.