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Figure 1. Wilms' tumor in a 28-month-old girl. (A) Abdominal CT scan before and (B) after preoperative chemotherapy.
(Figure omitted. See article PDF.)
Figure 2. Operative field and laparoscopic view of Wilms' tumor during dissection.
(Figure omitted. See article PDF.)
Figure 3. Removal of the intact tumor and postoperative abdominal view.
(Figure omitted. See article PDF.)
Figure 4. Late postoperative period: excellent cosmetic appearance of abdomen.
(Figure omitted. See article PDF.)
The well-recognized benefits of minimally invasive surgery (MIS), such as reduced pain, minimal blood loss, early discharge, rapid recovery and minimal scars, as well as less intracavitary adhesion formation, have encouraged surgeons to expand its use to many diseases of adults and also children [1-6].
The first reported use of MIS for pediatric cancer came in 1994, when Blucher and Lobe [7] commented on the use of laparoscopy for the diagnosis and staging of suspected intra-abdominal malignancies. Since then, MIS has been used for the management of children with cancer for initial diagnosis, staging, palliation of unresectable disease, curative resection, second-look surgeries, exploration of recurrent disease and lymph node biopsy [3,8].
Spurbeck et al. [9], Waldhausen et al. [10] and Sandoval et al. [11] described their experience with laparoscopy in children with cancer and concluded that MIS is safe and effective for tumor biopsy, but its role in tumor resection remains to be defined. Other authors reported successful laparoscopic resection of abdominal tumors [12-14].
Most of the published experience with MIS for pediatric retroperitoneal tumors refers to neuroblastoma and other adrenal tumors with high success rate [15-20]. Table 1 shows the reported series on MIS for pediatric tumors.
Recently, we have successfully extended this procedure to the treatment of Wilms' tumor [21,22] and we will describe our encouraging experience here.
Study design
A prospective study of MIS for the treatment of children with Wilms' tumor after preoperative chemotherapy was carried out at our institution.
The Brazilian Cooperative Group for the treatment of Wilms' tumor is committed to the International Society of Pediatric Oncology (SIOP) 2001 protocol, therefore, all our patients receive preoperative chemotherapy. In selected cases, this approach has offered the opportunity to apply laparoscopic radical nephrectomy to these patients, with the advantages of MIS.
All children with a renal mass tumor admitted...