Indications for Minimally Invasive Surgery in Pediatric Oncology

Abstract

Background

: The role of minimally invasive surgery (MIS) in children is gradually expanding. However, the indications for its utilization in children with cancer are currently unclear. An attempt was made in the mid 1990s to define this role through a federally funded study coordinated by the Children's Cancer Group and the Pediatric Oncology Group. However, this study was closed because of lack of general support.

Methods

: A survey of leading pediatric surgical oncologists and experienced endoscopic surgeons was recently completed to gain a consensus for current indications for MIS in the pediatric cancer patient.

Results

: Among the surveyed respondents, it was determined that biopsy of lesions, performed either laparoscopically or thoracoscopically, is the clearest indication for use of this technique. Excision of peripheral pulmonary nodules is also appropriate except, perhaps, in the patient with osteogenic sarcoma, as most of the respondents feel palpation is important for complete evaluation of the pulmonary parenchyma in these patients. Resection of solid organs with tumor may be feasible in the future but should at present be employed only in selected circumstances and by experienced surgeons.

Conclusions

: With the survey, a better understanding of the indications for MIS in the pediatric cancer patient has emerged. In the future, it is likely that MIS will become part of some cancer study protocols.