MINIMALLY INVASIVE SURGERY IN CHILDREN WITH CANCER

Background. The safety and efficacy of minimally invasive oncologic pr ocedures in children have not been well defined and only limited anecd otal experience has been published. Methods. A retrospective review of all patients undergoing either a laparoscopic or thoracoscopic proced ure at Childrens Cancer Group institutions between December 1, 1991, a nd October 1, 1993, was performed. Results. Eighty-five children under went 88 minimally invasive surgical procedures as part of the evaluati on or treatment for cancer at 15 participating centers. In 25 patients , laparoscopy was performed and 60 patients underwent 63 thoracoscopic operations. Tissue biopsies were taken in 67 cases and diagnostic mat erial was obtained in 99% of the biopsies. Seven complications occurre d, all within the thoracoscopic group. These included conversion of si x operations to an open procedure. One patient developed atelectasis p ostoperatively. Conclusions. In pediatric patients with suspected canc er, laparoscopy was highly accurate with minimal morbidity; thoracosco py was nearly as efficient with slightly higher morbidity, Both modali ties are useful for assessment of resectability, for staging purposes, and for evaluation of recurrent or metastatic disease.