Pediatric Surgery Division, Hospital Italiano de Buenos Aires, Tte. Gral. J. D. Perón, 4190, Buenos Aires, Argentina.
Pediatr Surg Int. 2022 Oct;38(10):1435-1444. doi: 10.1007/s00383-022-05188-x. Epub 2022 Jul 25.
To analyze the role of laparoscopic surgery for the management of pediatric adrenal tumors (AT).
Retrospective analysis of children diagnosed with AT, operated laparoscopically during 2003-2020. The strategy differed according to tumor extension. AT < 6 cm were resected. Locally advanced tumors (L2) or > 6 cm were biopsied.
N = 28. Complete tumor resection (R0) in 20 (71%), tumor biopsy in 8 (R2). Age (median): 28.8 months (2 months-18 years). 14/28 left-sided, 2 bilateral. Median operating time: 78 min (45-180). Mean tumor size (for resections): 4 cm (2.5-6). Tumor pathology: neuroblastoma (n = 17), Ganglioneuroma (n = 7), Adrenocortical carcinoma (n = 1), Osteosarcoma metastasis (n = 1), Pheochromocytoma (n = 1), Venous malformation (n = 1). Mean hospital stay: 2.5 days (1-3). Mean follow up: 65.5 months (24-192). Overall survival and event-free survival were 86 and 75%, respectively (5 years event-free survival for neuroblastoma: 33% [intermediate risk], 16.6% [high risk]. No surgery-related mortality.
Laparoscopic surgery for adrenal tumors is safe. Laparoscopic biopsy is useful for unresectable tumors when a percutaneous approach is not possible. With the proposed selection criteria, the laparoscopic approach should be the first option for resection of small and localized AT in pediatrics.
分析腹腔镜手术在小儿肾上腺肿瘤（AT）治疗中的作用。
回顾性分析 2003 年至 2020 年间经腹腔镜手术治疗的儿童 AT 患者。根据肿瘤的扩展情况采用不同的治疗策略。肿瘤直径＜6cm 者行肿瘤切除术，局部进展性肿瘤（L2）或＞6cm 者行肿瘤活检术。
共纳入 28 例患儿，其中 20 例行肿瘤完全切除术（R0），8 例行肿瘤活检术（R2）。年龄中位数为 28.8 个月（2 个月至 18 岁），左侧 14 例，双侧 2 例。中位手术时间为 78 分钟（45-180 分钟）。肿瘤平均最大径（用于评估切除术）为 4cm（2.5-6cm）。肿瘤病理：神经母细胞瘤 17 例，节细胞神经瘤 7 例，肾上腺皮质癌 1 例，骨肉瘤转移 1 例，嗜铬细胞瘤 1 例，静脉畸形 1 例。平均住院时间为 2.5 天（1-3 天）。平均随访时间为 65.5 个月（24-192 个月）。总生存率和无事件生存率分别为 86%和 75%（5 年无事件生存率：神经母细胞瘤低危组为 33%，高危组为 16.6%）。无手术相关死亡病例。
腹腔镜手术治疗小儿肾上腺肿瘤是安全的。对于无法进行经皮治疗的无法切除的肿瘤，腹腔镜活检术是有用的。根据本研究提出的选择标准，腹腔镜手术应成为小儿小且局限性 AT 切除的首选治疗方法。
