Role of diagnostic and ablative minimally invasive surgery for pediatric malignancies
Role of diagnostic and ablative minimally invasive surgery for pediatric malignancies
复制标题
DOI：
10.1002/cncr.22696
复制
发表时间：
2007-06-01
期刊：
影响因子：
6.2
通讯作者：
Ure, Benno M.
中科院分区：
文献类型：
--
作者：
Metzelder, Martin L.;Kuebler, Joachim F.;Ure, Benno M.
背景微创手术（MIS）在儿科癌症中的应用是一个有争议的问题。MIS的诊断和消融作用进行了评估，在一个连续的系列儿童恶性肿瘤。2000年9月至2005年12月进行了一项前瞻性研究，包括所有因确诊或高度怀疑儿童癌症而接受腹部和胸部手术的患者。一个跨学科小组批准了微创或传统手术的适应症。在一个机构，对276名癌症儿童进行了301次手术。其中90例患者（30%）尝试了微创入路，69例（77%）手术成功。然而，21例手术（23%）转为开放手术。在腹腔镜下腹部手术中，41例（53%）腹腔镜下腹部活检或分期手术，但6例转换。总共进行了139次腹部切除术，24次尝试腹腔镜手术。其中10个（42%）已转换。在34例需要活检的胸部手术中，14例（41%）尝试了胸腔镜检查，除1例（93%）外，其余均成功。51例胸部肿瘤被切除，11例（22%）尝试胸腔镜入路，7例（14%）成功。从微创手术转为开放手术主要是由于能见度有限。发生3例出血并发症，1例患者需要输血。此外，1例小肠损伤发生在腹腔镜下立即闭合。在平均39个月后，没有端口部位复发。MIS是一个可靠的诊断工具，小儿腹部和胸部恶性肿瘤。消融MIS在儿科癌症中的作用仍然有限。
BACKGROUND. The 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.METHODS. A 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.RESULTS. At a single institution, 301 operations were performed oil 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.CONCLUSIONS. MIS is a reliable diagnostic tool for pediatric abdominal and thoracic malignancy. The role of ablative MIS in pediatric cancer remains limited.