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J Pediatr Urol. 2014 Jun;10(3):488-94. doi: 10.1016/j.jpurol.2013.11.002. Epub 2013 Nov 23.

Comparison between laparoscopic and open radical nephrectomy for the treatment of primary renal tumors in children: single-center experience over a 5-year period.

Author information

1
Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Divisions of Urology and General Surgery, IWK Health Centre, Dalhousie University, Halifax, NS, Canada.
2
Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Division of Urology, Alberta Children's Hospital, University of Alberta, Calgary, AB, Canada.
3
Division of General and Thoracic Surgery, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
4
Department of Pediatrics, Division of Oncology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
5
Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
6
Division of Urology, McMaster Children's Hospital and McMaster University, Hamilton, ON, Canada.
7
Division of Urology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada. Electronic address: armando.lorenzo@sickkids.ca.

Abstract

OBJECTIVES:

To compare the outcomes of laparoscopic nephrectomy (LN) with open radical nephrectomy (ORN) in the management of consecutive pediatric neoplasms.

PATIENTS AND METHODS:

Retrospective cohort study of consecutive children treated for primary renal tumors between 2006 and 2011, segregated based on surgical modality (LN/ORN). Pre-, intra- and postoperative data and outcomes were collected.

RESULTS:

Demographics from the 45 patients (13 LN, 32 ORN) were similar, and tumors in the LN group were smaller [6.59 ± 1.8 cm vs. 10.99 ± 2.99 cm ORN (p < 0.05)]. Six patients had preoperative chemotherapy (two LN, four ORN). No tumor ruptures occurred with either technique. Wilms tumor (seven LN, 24 ORN) was the most common diagnosis, followed by renal cell carcinoma (four LN, four ORN). Procedure length was similar between groups (282 ± 79 LN, 263 ± 81 min ORN). Mean length of stay was significantly shorter for LN (2.9 vs. 5.9 days; p = 0.002). Postoperative narcotic requirements and use of nasogastric tube were higher in the ORN group. After a median follow-up of 18 (LN) and 33 months (ORN), 1 and 4 recurrences occurred, respectively.

CONCLUSIONS:

LN is an attractive alternative to open surgery in carefully selected cases of pediatric renal tumors. Procedure length and incidence of intra-operative rupture were not increased, while post-operative recovery and hospital stay were shorter for LN. Longer follow-up is mandatory to confirm comparable oncological outcomes to ORN.

KEYWORDS:

Children; Laparoscopy; Nephrectomy; Renal neoplasm; Wilms' tumor

PMID:
24331167
DOI:
10.1016/j.jpurol.2013.11.002
[Indexed for MEDLINE]

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