Maintaining oncologic integrity with minimally invasive resection of pediatric embryonal tumors.
Maintaining oncologic integrity with minimally invasive resection of pediatric embryonal tumors.
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DOI：
10.1016/j.surg.2018.03.020
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发表时间：
2018-08
期刊：
影响因子：
3.8
通讯作者：
Lovvorn HN 3rd
中科院分区：
文献类型：
--
作者：
Phelps HM;Ayers GD;Ndolo JM;Dietrich HL;Watson KD;Hilmes MA;Lovvorn HN 3rd
胚胎性肿瘤通常发生在婴儿和幼儿中，通常在发病时体积很大。手术切除是胚胎性肿瘤多模式治疗的基石，但可能会破坏治疗时间表。如果使用得当，微创手术可以最大限度地减少治疗延误。然而，微创胚胎肿瘤切除的肿瘤学完整性和安全性仍然存在争议。范德比尔特癌症登记处的查询确定了所有在15年期间接受腔内胚胎性肿瘤治疗的儿童。在诊断时、切除前和切除后对肿瘤进行影像学评估，以测量体积（mL）和图像定义的危险因素（仅限神经母细胞肿瘤）。比较微创手术和开放切除同等大小肿瘤的患者和肿瘤特征、围手术期细节和肿瘤预后。202例患者共206例腔内胚胎性肿瘤，其中开放切除178例（n = 152, 85%）或微创手术切除178例（n = 26, 15%）。对于体积小于100 mL的肿瘤，微创手术和开放切除后的5年生存率、无复发生存率和总生存率无显著差异（P = 0.249, P = 0.124）。两种手术入路在切缘状态和淋巴结取样方面均无差异（p = 0.333和p = 0.070）。微创手术的优势是出血量减少（P < 0.001），手术时间缩短（P = 0.002），住院时间缩短（P < 0.001）。通常，微创手术用于体积较小和早期无图像确定危险因素的神经母细胞肿瘤。当选择适当时，微创切除儿童胚胎性肿瘤，特别是神经母细胞肿瘤，提供可接受的肿瘤完整性。肿瘤体积大，患者体型小，图像确定的危险因素可能限制了微创手术的广泛适用性。
Embryonal tumors arise typically in infants and young children and are often massive at presentation. Operative resection is a cornerstone in the multimodal treatment of embryonal tumors but potentially disrupts therapeutic timelines. When used appropriately, minimally invasive surgery can minimize treatment delays. The oncologic integrity and safety attainable with minimally invasive resection of embryonal tumors, however, remains controversial. Query of the Vanderbilt Cancer Registry identified all children treated for intracavitary, embryonal tumors during a 15-year period. Tumors were assessed radiographically to measure volume (mL) and image-defined risk factors (neuroblastic tumors only) at time of diagnosis, and at preresection and postresection. Patient and tumor characteristics, perioperative details, and oncologic outcomes were compared between minimally invasive surgery and open resection of tumors of comparable size. A total of 202 patients were treated for 206 intracavitary embryonal tumors, of which 178 were resected either open (n = 152, 85%) or with minimally invasive surgery (n = 26, 15%). The 5-year, relapse-free, and overall survival were not significantly different after minimally invasive surgery or open resection of tumors having a volume less than 100 mL, corresponding to the largest resected with minimally invasive surgery (P = .249 and P = .124, respectively). No difference in margin status or lymph node sampling between the 2 operative approaches was detected (p = .333 and p = .070, respectively). Advantages associated with minimally invasive surgery were decreased blood loss (P < .001), decreased operating time (P = .002), and shorter hospital stay (P < .001). Characteristically, minimally invasive surgery was used for smaller volume and earlier stage neuroblastic tumors without image-defined risk factors. When selected appropriately, minimally invasive resection of pediatric embryonal tumors, particularly neuroblastic tumors, provides acceptable oncologic integrity. Large tumor volume, small patient size, and image-defined risk factors may limit the broader applicability of minimally invasive surgery.
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