Laparoscopic approach of pediatric adrenal tumors
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In brief
In brief
Retrospective study of 28 pediatric adrenal tumor cases demonstrates laparoscopic surgery is safe and effective for tumors under 6 cm, achieving complete resection in 71% with minimal hospital stay. Neuroblastoma was most common pathology; laparoscopic biopsy proved valuable for unresectable cases when percutaneous approach not feasible.
Written by the GCMD Library team from the article.
Abstract
Purpose
To analyze the role of laparoscopic surgery for the management of pediatric adrenal tumors (AT).
Methods
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.
Results
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.
Conclusion
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.