Varlet François, Petit Thierry, Leclair Marc-David, Lardy Hubert, Geiss Stephan, Becmeur François, Ravasse Philippe, Rod Julien, de Lambert Guénolée, Braik Karim, Lardellier-Reynaud Florence, Lopez Manuel
Department of Pediatric Surgery, Centre Hospitalier Universitaire, Hopital Nord, Saint-Etienne, France.
Department of Pediatric Surgery, Centre Hospitalier Universitaire, Caen, France.
J Pediatr Urol. 2014 Jun;10(3):500-5. doi: 10.1016/j.jpurol.2013.11.005. Epub 2013 Nov 25.
The aim was to report a multicentric study with a longer follow-up to evaluate the laparoscopic radical nephrectomy in children with renal cancer.
This was a retrospective multicentric study, from October 2005 to January 2012, of children who underwent a laparoscopic radical nephrectomy for small renal malignant tumors.
Seventeen children were included in this study. Sixteen underwent chemotherapy before surgery according the SIOP (Société Internationale d'Oncologie Pédiatrique) protocol and one was treated by surgery only for a carcinoma. All except one could be treated by laparoscopy; the biggest tumoral size was 8 cm. The median hospital stay was 3 days (2-10). The pathologic examination showed 15 Wilms' tumors, one clear cell sarcoma and one TFE3 renal cell carcinoma. With a median follow-up of 42 months (range 12 and 77 months) after laparoscopic radical nephrectomy, 15 children had no oncological complications (port site or local recurrence, pulmonary metastasis) and one had a local recurrence without intraoperative tumoral rupture. The child with TFE3 renal cell carcinoma died 4 years after surgery from brain and lung metastases without local recurrence. No small bowel obstruction occurred.
Radical nephrectomy in children for Wilms' tumor or other renal cancer can be safely performed laparoscopically and our indications can be summarized, for trained laparoscopic surgeons, by small tumors under about 8 cm diameter, especially without crossing the lateral edge of the vertebra on the CT scan at the time of surgery.
本研究旨在报告一项随访时间更长的多中心研究,以评估腹腔镜根治性肾切除术在儿童肾癌中的应用。
这是一项回顾性多中心研究,研究对象为2005年10月至2012年1月期间因小肾恶性肿瘤接受腹腔镜根治性肾切除术的儿童。
本研究纳入了17名儿童。16名儿童根据国际小儿肿瘤学会(SIOP)方案在手术前接受了化疗,1名儿童仅接受了手术治疗以治疗癌症。除1名儿童外,其他所有儿童均可行腹腔镜手术治疗;最大肿瘤直径为8 cm。中位住院时间为3天(2 - 10天)。病理检查显示15例为肾母细胞瘤,1例为透明细胞肉瘤,1例为TFE3肾细胞癌。腹腔镜根治性肾切除术后的中位随访时间为42个月(范围为12至77个月),15名儿童无肿瘤并发症(切口部位或局部复发、肺转移),1名儿童出现局部复发但术中肿瘤未破裂。患有TFE3肾细胞癌的儿童在手术后4年死于脑和肺转移,无局部复发。未发生小肠梗阻。
对于肾母细胞瘤或其他肾癌患儿,腹腔镜根治性肾切除术可安全实施。对于训练有素的腹腔镜外科医生,我们的适应证可总结为:直径约8 cm以下的小肿瘤,尤其是在手术时CT扫描未越过椎体外侧缘者。