Minimally invasive surgery and childhood cancer

Pediatric thoraco-abdominal tumors are rare and specific. The role of minimally invasive surgery (MAS) in the management of such tumor still remains poorly defined. If simple procedures like biopsy, supportive care procedures, second-look are today accepted by pediatric oncologists and surgeons, using MAS for curative removal remains debatable. Our experience. Over a 16 years period, 85 potentially malignant tumors have been resected: 19 thoracic tumors (12 neurogenic tumors, 3 metastatic lesions, 2 teratomas, 1 thymona, 1 lipoma); 66 abdominal tumors (36 ovarian tumors, 14 neurogenic tumors, 6 pancreatic, 4 hepatic, 3 sacroccygeal teratomas, 1 renal tumor, 2 various). Out of 85 cases only 16 cases have been confirmed as malignant tumors. After a 4 years mean follow up, no "oncologic" complications occurred, in particular no port site recurrence. D ISCUSSION: Some tumors are well suited for MAS removal : ovarian tumor, thoracic ganglioneuroblastoma, small adrenal tumor. MAS for nephroblastoma is at its very beginning. Potential benefits of MAS have not been definitively proved. Comparative multicenter trials under the control of national and international pediatric oncologic societies are initiated today, although various obstacles exist to conduct such trials. Conclusion. The advantages of MAS versus open surgery remain laudable goals but disease free overall survival is more important outcome for children undergoing treatment for cancer. Application of MAS to children with cancer must be critically evaluated with a long follow up.