Minimally invasive and robotic-assisted approaches applied to pediatric surgical oncology.

The management of pediatric tumors is complex, with surgery, chemotherapy, and radiotherapy being cornerstones in their treatment. Tumor removal is increasingly performed by a minimally invasive approach, which allows for quicker postoperative recovery and less postoperative pain. The goal of this report is to give an overview of minimally invasive surgical approaches for common pediatric tumors, with a focus on technical considerations and postoperative outcomes.

Current surgical approaches to pediatric renal tumors.

Pediatric renal tumors are among the most common pediatric solid malignancies. Surgical resection is a key component in the multidisciplinary therapy for children with kidney tumors. Therefore, it is imperative that surgeons caring for children with renal tumors fully understand the current standards of care in order to provide appropriate surgical expertise within this multimodal framework. Fortunately, the last 60 years of international, multidisciplinary pediatric cancer cooperative group studies have enabled high rates of cure for these patients. This review will highlight the international surgical approaches to pediatric patients with kidney cancer to help surgeons understand the key differences and similarities between the European (International Society of Pediatric Oncology) and North American (Children's Oncology Group) recommendations.

Thoracoscopic external traction suture elongation for the management of long-gap oesophageal atresia: a two-centre experience.

AIM: Van der Zee (VdZ) described a technique to elongate the oesophagus in long-gap oesophageal atresia (LGOA) by thoracoscopic placement of external traction sutures (TPETS). Here, we describe our experience of using this technique. METHOD: Retrospective review of all LGOA + / - distal tracheo-oesophageal fistula (dTOF) cases where TPETS was used in our institutions. Data are given as medians (IQR). RESULTS: From 01/05/2019 to 01/03/2023, ten LGOA patients were treated by the VdZ technique. Five had oesophageal atresia (Gross type A or B, Group 1) and five had OA with a dTOF (type C, Group 2) but with a long gap precluding primary anastomosis. Age of first traction procedure was Group 1 = 53 (29-55) days and Group 2 = 3 (1-49) days. Median number of traction procedures = 3; time between first procedure and final anastomosis was 6 days (4-7). Four cases were converted to thoracotomy at the third procedure. Three had anastomotic leaks managed conservatively. Follow-up was 12-52 months. All patients achieved oesophageal continuity and were orally fed; no patient required an oesophagostomy. CONCLUSION: In this series, TPETS in LGOA facilitated delayed primary anastomoses and replicated the good results previously described but, in addition, was successful in cases with dTOF. We believe traction suture placement and tensioning benefit from being performed thoracoscopically because of excellent visualisation and the fact that the tension does not change when the chest is closed. Surgical and anaesthetic planning and expertise are crucial. It is now our management of choice in OA patients with a long gap with or without a distal TOF.

Intraparenchymal Indocyanine Green Use Improves Nodal Yield During Minimally Invasive Tumor Nephrectomy in Children.

Introduction: Correctly identifying positive lymph nodes associated with pediatric renal tumors is key to guiding management. Recommended targets for lymph node sampling are commonly missed during tumor nephrectomy, particularly if minimally invasive surgery (MIS) is performed. Indocyanine green (ICG) is used for lymph node mapping in adult oncology with excellent efficacy and safety profile. Materials and Methods: A prospective study was undertaken at a single-quaternary-level pediatric surgery center. All patients undergoing MIS radical or partial nephrectomy for renal tumors 2016-2023 were included. Patients managed from 2020 onwards received intra-parenchymal ICG prior to lymph node sampling. Main Results: Twenty-five patients underwent MIS nephrectomy at mean age 2 years 10 months. Eighteen patients were pre-ICG and 7 received ICG. ICG administration successfully demonstrated fluorescent nodes in all patients. Median number of nodes sampled was three pre-ICG and seven with ICG (P = 0.009). Forty-six nodes were sampled across 7 ICG patients-33 fluorescent, 10 non-fluorescent, and 3 identified histologically. Three nodes overall contained active disease, two pre-ICG and one fluorescent node with ICG. Neither operative time (180 pre-ICG versus 161 minutes ICG, P = 0.7) nor length of stay (72 versus 84 hours, P = 0.3) were significantly affected by ICG administration. There were no adverse events associated with ICG use. Conclusions: ICG is safe and effective at identifying nodes in MIS resection of pediatric renal tumors with the potential to increase the number of nodes sampled. Further research is needed, specifically a randomized control trial with extended follow-up.